Provider Demographics
NPI:1568975035
Name:COVERSON A&G HOLDINGS, LLC
Entity Type:Organization
Organization Name:COVERSON A&G HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:STURRUP
Authorized Official - Last Name:COVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-562-6699
Mailing Address - Street 1:19320 NW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3258
Mailing Address - Country:US
Mailing Address - Phone:954-562-6699
Mailing Address - Fax:
Practice Address - Street 1:19320 NW 8TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-3258
Practice Address - Country:US
Practice Address - Phone:954-562-6699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities