Provider Demographics
NPI:1083321863
Name:COVENANT BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:COVENANT BEHAVIORAL HEALTH SERVICES
Other - Org Name:ROYAL PRINCESS DEVELOPMENTAL INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADENIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:AKOREDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-964-7983
Mailing Address - Street 1:1045 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-2622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1045 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-2622
Practice Address - Country:US
Practice Address - Phone:708-964-7983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROYAL PRINCESS DEVELOPMENTAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-01
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health