Provider Demographics
NPI:1417254285
Name:COVENANT CARE, LLC
Entity Type:Organization
Organization Name:COVENANT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KARON
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-224-9944
Mailing Address - Street 1:6 W COUNTY ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23663-2336
Mailing Address - Country:US
Mailing Address - Phone:757-224-9944
Mailing Address - Fax:757-224-2659
Practice Address - Street 1:6 W COUNTY ST
Practice Address - Street 2:SUITE 108
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23663-2336
Practice Address - Country:US
Practice Address - Phone:757-224-9944
Practice Address - Fax:757-224-2659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-11669251E00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251E00000XAgenciesHome Health