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General NPI Number Information
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NPI Number | 1710348370
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Entity Type | Organization
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Legal Business Name | COVENANT PREMIUM SENIOR CARE
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Dates
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Enumeration Date | 03/10/2016
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 28307 SUGARSIDE GLEN DR
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City | KATY
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State | TX
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Zip | 77494-1480
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Country | US
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Telephone | 281-394-9217
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Fax | 281-394-9216
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Provider Business Mailing Address
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Address Line | 2918 CHAPEL ROCK
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City | KATY
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State | TX
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Zip | 77494-5256
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Country | US
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Telephone | 281-394-9217
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Fax | 281-394-9216
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Authorized Official
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Title or Position | PRESIDENT & CHAIRMAN
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Name | DR. DERRICK JACKSON
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Credential | PHD
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Telephone | 281-394-9217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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