Provider Demographics
NPI:1114784642
Name:ROYAL COVENANT HOME NURSING AGENCY
Entity Type:Organization
Organization Name:ROYAL COVENANT HOME NURSING AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY MANAGER
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:708-964-7983
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 DEVELOPMENT INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care