Provider Demographics
NPI:1417139619
Name:COVENANT HOSPICE & PALLIATIVE CARE LLC
Entity Type:Organization
Organization Name:COVENANT HOSPICE & PALLIATIVE CARE LLC
Other - Org Name:COVENANT HP CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:G
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-309-5668
Mailing Address - Street 1:10 CADILLAC DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1001
Mailing Address - Country:US
Mailing Address - Phone:615-377-7022
Mailing Address - Fax:615-373-4457
Practice Address - Street 1:2630 WEST FWY STE 130
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-7117
Practice Address - Country:US
Practice Address - Phone:817-735-8741
Practice Address - Fax:817-735-8836
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COVENANT HOSPICE & PALLIATIVE CARE, L.P.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-29
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011688251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-1791OtherMEDICARE PROVIDER NUMBER
TX011688OtherSTATE HOSPICE LICENSE