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NPI Code Detail

MEDICARE: COVENANT BPEY HOLDINGS, LLC

MEDICARE: COVENANT BPEY HOLDINGS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251C00000XDevelopmentally Disabled Services Day Training Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134541725
Entity Type Code : Organization
Provider Name (Legal Business Name) : COVENANT BPEY HOLDINGS, LLC
Provider Business Mailing Address
First Line : 806 TOWNE PARK DR STE 100
Second Line : P. O. BOX 1082
City : RINCON
State : GA
Zip : 31326-9369
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 806 TOWNE PARK DR STE 100
Second Line :
City : RINCON
State : GA
Zip : 31326-9369
Country : US
Telephone Number : 912-826-3883
Fax Number : 866-492-2196
Authorized Official
Title or Position : CEO
Name : MR. YEMI SONAIKE
Credential :
Telephone Number : 912-826-3883
Provider Enumeration Date : 01/15/2014
Last Update Date : 01/15/2014

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Directions to “COVENANT BPEY HOLDINGS, LLC ” Practice Location

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