Provider Demographics
NPI:1275307621
Name:COVENANT TRANSPORTATION INC.
Entity Type:Organization
Organization Name:COVENANT TRANSPORTATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:WANTATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-881-8668
Mailing Address - Street 1:167 N MAIN ST APT A
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-2020
Mailing Address - Country:US
Mailing Address - Phone:978-881-8668
Mailing Address - Fax:617-527-0680
Practice Address - Street 1:167 N MAIN ST APT A
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-2020
Practice Address - Country:US
Practice Address - Phone:617-527-0680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No171W00000XOther Service ProvidersContractorGroup - Single Specialty