Provider Demographics
NPI:1447764287
Name:COVENANT LIFE MANAGEMENT, LLC
Entity Type:Organization
Organization Name:COVENANT LIFE MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-478-5953
Mailing Address - Street 1:485 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-5541
Mailing Address - Country:US
Mailing Address - Phone:423-478-5953
Mailing Address - Fax:
Practice Address - Street 1:485 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-5541
Practice Address - Country:US
Practice Address - Phone:423-478-5953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherHOME OFFICE