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General NPI Number Information
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NPI Number | 1952890790
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Entity Type | Organization
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Legal Business Name | COMFORT COVENANT HOME CARE LLC
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Dates
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Enumeration Date | 05/08/2018
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 3039 N POST RD STE 1356
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City | INDIANAPOLIS
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State | IN
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Zip | 46226-6543
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Country | US
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Telephone | 205-335-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 16165 N 83RD AVE STE 200
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City | PEORIA
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State | AZ
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Zip | 85382-5816
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Country | US
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Telephone | 205-335-7777
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DOMINIQUE BROUNSON
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Credential |
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Telephone | 205-335-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health 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 | 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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