Provider Demographics
NPI:1437465598
Name:THE COVENANT HOUSE
Entity Type:Organization
Organization Name:THE COVENANT HOUSE
Other - Org Name:THE COVENANT HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:HEARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-575-0070
Mailing Address - Street 1:106 SOUTH JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:MT. PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-4451
Mailing Address - Country:US
Mailing Address - Phone:903-575-0070
Mailing Address - Fax:903-575-0879
Practice Address - Street 1:106 SOUTH JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:MT. PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-4451
Practice Address - Country:US
Practice Address - Phone:903-575-0070
Practice Address - Fax:903-575-0879
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEST FRIENDS ADULT ACTIVITY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-27
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130306314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001000874Medicaid
TX130306Medicaid