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General NPI Number Information
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NPI Number | 1730301979
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Entity Type | Organization
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Legal Business Name | COVENANT HOME SERVICES
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 10/18/2013
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Provider Practice Location Address
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Address Line | 3755 E MAIN ST SUITE 165
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City | ST CHARLES
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State | IL
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Zip | 60174-2463
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Country | US
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Telephone | 630-845-0680
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Fax | 630-444-1688
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Provider Business Mailing Address
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Address Line | 3755 E MAIN ST SUITE 165
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City | ST CHARLES
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State | IL
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Zip | 60174-2463
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Country | US
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Telephone | 630-845-0680
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Fax | 630-444-1688
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSEPH D HAUGHNEY
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Credential |
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Telephone | 630-845-0680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 4000133
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License Number State | IL
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