Provider Demographics
NPI: | 1356077838 |
---|---|
Name: | COVERESPITE HOME, LLC |
Entity Type: | Organization |
Organization Name: | COVERESPITE HOME, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OPERATIONAL MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CHERYL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MORGAN-NORMAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | BSN, RN |
Authorized Official - Phone: | 501-760-8997 |
Mailing Address - Street 1: | 224 MAGNET COVE RD |
Mailing Address - Street 2: | |
Mailing Address - City: | MALVERN |
Mailing Address - State: | AR |
Mailing Address - Zip Code: | 72104-7905 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 501-760-8997 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 224 MAGNET COVE RD |
Practice Address - Street 2: | |
Practice Address - City: | MALVERN |
Practice Address - State: | AR |
Practice Address - Zip Code: | 72104-7905 |
Practice Address - Country: | US |
Practice Address - Phone: | 501-760-8997 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-07-27 |
Last Update Date: | 2022-07-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 385H00000X | Respite Care Facility | Respite Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AR | 38027 | Other | DHS, DAAS |
AR | 5816 | Other | HEALTH FACILITY SVC, DOH |