Provider Demographics
NPI:1033280094
Name:COVENANT HEALTH CARE CENTER, INC
Entity Type:Organization
Organization Name:COVENANT HEALTH CARE CENTER, INC
Other - Org Name:MICHAELSEN HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MALZAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-878-4430
Mailing Address - Street 1:700 WEST FABYAN PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-1247
Mailing Address - Country:US
Mailing Address - Phone:630-879-4000
Mailing Address - Fax:630-879-1153
Practice Address - Street 1:700 WEST FABYAN PARKWAY
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1247
Practice Address - Country:US
Practice Address - Phone:630-879-4000
Practice Address - Fax:630-879-1153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0025577314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0598610002OtherDMERC
IL=========002Medicaid
IL=========002Medicaid