Provider Demographics
NPI:1508056896
Name:THE COVENANT HOME CARE SERVICES, INC
Entity Type:Organization
Organization Name:THE COVENANT HOME CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:OLUSOLA
Authorized Official - Middle Name:OLUKEMI
Authorized Official - Last Name:AJELETI-OLUFADEJU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-884-1411
Mailing Address - Street 1:2440 TEXAS PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-4022
Mailing Address - Country:US
Mailing Address - Phone:832-884-1411
Mailing Address - Fax:281-499-4902
Practice Address - Street 1:2440 TEXAS PKWY STE 150
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-4022
Practice Address - Country:US
Practice Address - Phone:832-884-1411
Practice Address - Fax:281-499-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011158251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX743132Medicare Oscar/Certification