Provider Demographics
NPI:1003088329
Name:COVINGTON LEGACY INCORPORATED
Entity Type:Organization
Organization Name:COVINGTON LEGACY INCORPORATED
Other - Org Name:FAMILY FRIEND RESPITE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:GUY
Authorized Official - Last Name:COVINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:850-997-8457
Mailing Address - Street 1:8436 GAMBLE RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-7397
Mailing Address - Country:US
Mailing Address - Phone:850-997-8457
Mailing Address - Fax:850-997-8457
Practice Address - Street 1:8436 GAMBLE RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-7397
Practice Address - Country:US
Practice Address - Phone:850-997-8457
Practice Address - Fax:850-997-8457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN1061381385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care