Provider Demographics
NPI:1396038907
Name:COVENANT MEDICAL COMPANY, LLC
Entity Type:Organization
Organization Name:COVENANT MEDICAL COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIMEZIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:AMANAMBU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-920-6227
Mailing Address - Street 1:PO BOX 13901
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44334-3901
Mailing Address - Country:US
Mailing Address - Phone:330-920-6227
Mailing Address - Fax:330-920-6228
Practice Address - Street 1:2408 STATE RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1504
Practice Address - Country:US
Practice Address - Phone:330-920-6227
Practice Address - Fax:330-620-6228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies