Provider Demographics
NPI:1407051444
Name:COVENANT COMMUNITY PARTNERS LLC
Entity Type:Organization
Organization Name:COVENANT COMMUNITY PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:MUNROE
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:919-475-9723
Mailing Address - Street 1:1803 CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-1175
Mailing Address - Country:US
Mailing Address - Phone:919-401-8000
Mailing Address - Fax:919-401-8005
Practice Address - Street 1:4000 WAKE FOREST RD
Practice Address - Street 2:SUITE 114
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6879
Practice Address - Country:US
Practice Address - Phone:919-876-8113
Practice Address - Fax:919-876-8114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301610Medicaid
NC8301610BMedicaid