Provider Demographics
NPI:1477786127
Name:COVENANT HOME SERVICES
Entity Type:Organization
Organization Name:COVENANT HOME SERVICES
Other - Org Name:COVENANTCARE AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUGHNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-878-4315
Mailing Address - Street 1:5700 OLD ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5800 SAINT CROIX AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55422-4446
Practice Address - Country:US
Practice Address - Phone:763-546-6125
Practice Address - Fax:763-546-8529
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COVENANT HOME SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health