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NPI Code Detail

MEDICARE: COVENANT COMMUNITY CARE, INC.

MEDICARE: COVENANT COMMUNITY CARE, INC.
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
1261QF0400XFederally Qualified Health Center (FQHC)4704195855MI
2261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1720134943
Entity Type Code : Organization
Provider Name (Legal Business Name) : COVENANT COMMUNITY CARE, INC.
Provider Business Mailing Address
First Line : 559 W GRAND BLVD
Second Line :
City : DETROIT
State : MI
Zip : 48216-2200
Country : US
Telephone Number : 313-554-1095
Fax Number :
Provider Business Practice Location Address
First Line : 5716 MICHIGAN AVE
Second Line :
City : DETROIT
State : MI
Zip : 48210-3039
Country : US
Telephone Number : 313-554-1095
Fax Number :
Authorized Official
Title or Position : CFO
Name : ANNA GRIEBEL CHAVEZ
Credential :
Telephone Number : 313-554-0485
Provider Enumeration Date : 01/28/2007
Last Update Date : 04/10/2023

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Directions to “COVENANT COMMUNITY CARE, INC. ” Practice Location

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