Provider Demographics
NPI:1558622886
Name:COVENANT IN HOME CARE LLC
Entity Type:Organization
Organization Name:COVENANT IN HOME CARE LLC
Other - Org Name:COVENANT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KINSLEY
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-364-2600
Mailing Address - Street 1:2400 FREDERICK AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2758
Mailing Address - Country:US
Mailing Address - Phone:816-364-2600
Mailing Address - Fax:816-901-3053
Practice Address - Street 1:2400 FREDERICK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2758
Practice Address - Country:US
Practice Address - Phone:816-364-2600
Practice Address - Fax:816-901-3053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities