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General NPI Number Information
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NPI Number | 1740626829
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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 | 05/16/2013
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Last Update Date | 04/01/2019
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Provider Practice Location Address
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Address Line | 125 N BROADWAY STE 1B
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City | TURLOCK
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State | CA
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Zip | 95380-4811
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Country | US
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Telephone | 209-664-2550
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Fax | 209-664-2557
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Provider Business Mailing Address
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Address Line | 5700 OLD ORCHARD ROAD
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City | SKOKIE
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State | IL
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Zip | 60077
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Country | US
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Telephone | 773-878-2295
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT OF HEALTH SERVICES
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Name | ELIZABETH MALZAHN
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Credential |
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Telephone | 773-878-4430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State | CA
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