Provider Demographics
NPI:1497784698
Name:ROSE OF SHARON COVENANT MINISTRIES
Entity Type:Organization
Organization Name:ROSE OF SHARON COVENANT MINISTRIES
Other - Org Name:COVENANT HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-889-1548
Mailing Address - Street 1:700 MORROW AVE
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134
Mailing Address - Country:US
Mailing Address - Phone:704-889-1548
Mailing Address - Fax:704-889-1180
Practice Address - Street 1:700 MORROW AVE
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-6528
Practice Address - Country:US
Practice Address - Phone:704-889-1548
Practice Address - Fax:704-889-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3145251E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601353Medicaid
NC3418009Medicaid