Provider Demographics
NPI:1235134545
Name:COVENANT HOSPICE, LLC
Entity Type:Organization
Organization Name:COVENANT HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:859-273-1225
Mailing Address - Street 1:3007 PARK CENTRAL AVE
Mailing Address - Street 2:UNIT B 5
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-9019
Mailing Address - Country:US
Mailing Address - Phone:859-273-1225
Mailing Address - Fax:859-273-9225
Practice Address - Street 1:1029 S 14TH ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-2742
Practice Address - Country:US
Practice Address - Phone:765-529-6667
Practice Address - Fax:765-529-7094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05-009876-1251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200385840Medicaid
IN151560Medicare Oscar/Certification