Provider Demographics
NPI:1205197456
Name:COVENANT CARE IN-HOME AGENCY LLC.
Entity Type:Organization
Organization Name:COVENANT CARE IN-HOME AGENCY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GELIS
Authorized Official - Middle Name:DEON
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-898-6916
Mailing Address - Street 1:5979 N. POINTE BLVD.
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63147
Mailing Address - Country:US
Mailing Address - Phone:314-381-0928
Mailing Address - Fax:314-383-2873
Practice Address - Street 1:6000 WEST FLORISSANT
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136
Practice Address - Country:US
Practice Address - Phone:314-381-0928
Practice Address - Fax:314-383-2873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care