Provider Demographics
NPI:1043490741
Name:COVENANT HEALTH SERVICES
Entity Type:Organization
Organization Name:COVENANT HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RRT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GILLIANS
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:817-909-9842
Mailing Address - Street 1:7923 DECOY DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4549
Mailing Address - Country:US
Mailing Address - Phone:817-909-9842
Mailing Address - Fax:
Practice Address - Street 1:7923 DECOY DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4549
Practice Address - Country:US
Practice Address - Phone:817-909-9842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69975227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGroup - Single Specialty