Provider Demographics
NPI:1407295280
Name:COVENANT FAMILY SOLUTIONS, LLC
Entity Type:Organization
Organization Name:COVENANT FAMILY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:DUSTIN
Authorized Official - Last Name:CHRISTENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:319-261-2292
Mailing Address - Street 1:1655 BLAIRS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-3157
Mailing Address - Country:US
Mailing Address - Phone:319-261-2292
Mailing Address - Fax:319-333-0092
Practice Address - Street 1:1655 BLAIRS FERRY RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302
Practice Address - Country:US
Practice Address - Phone:319-261-2292
Practice Address - Fax:319-333-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-14
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA600879703Medicaid