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General NPI Number Information
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NPI Number | 1720859242
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Entity Type | Organization
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Legal Business Name | COVENANT CAREGIVERS OF HATTIESBURG, LLC
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Dates
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Enumeration Date | 01/12/2024
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 201 S 27TH AVE STE 30
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City | HATTIESBURG
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State | MS
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Zip | 39401-7168
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Country | US
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Telephone | 601-856-5660
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Fax | 601-856-5709
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Provider Business Mailing Address
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Address Line | PO BOX 1481
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City | MADISON
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State | MS
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Zip | 39130-1481
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Country | US
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Telephone | 601-856-5660
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Fax | 601-856-5709
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Authorized Official
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Title or Position | OWNER
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Name | MIKE DAVIS
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Credential |
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Telephone | 601-966-7162
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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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