Provider Demographics
NPI:1407882822
Name:COVENANT CARE CENTER OF BIG SPRING, LLC
Entity Type:Organization
Organization Name:COVENANT CARE CENTER OF BIG SPRING, LLC
Other - Org Name:MOUNTAIN VIEW LODGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-717-5519
Mailing Address - Street 1:16203 CHASEMORE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-6603
Mailing Address - Country:US
Mailing Address - Phone:832-717-5519
Mailing Address - Fax:832-717-5519
Practice Address - Street 1:2009 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-5909
Practice Address - Country:US
Practice Address - Phone:432-263-1271
Practice Address - Fax:432-263-5338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004921313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
67-5761Medicare ID - Type Unspecified