Provider Demographics
NPI:1144583915
Name:COVENANT HOMECARE
Entity Type:Organization
Organization Name:COVENANT HOMECARE
Other - Org Name:COVENANT HOME MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-374-0602
Mailing Address - Street 1:8035 ROANE MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-8334
Mailing Address - Country:US
Mailing Address - Phone:865-374-0600
Mailing Address - Fax:865-374-2061
Practice Address - Street 1:8035 ROANE MEDICAL CENTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8334
Practice Address - Country:US
Practice Address - Phone:865-374-0600
Practice Address - Fax:865-374-2061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6927950001Medicare PIN