Provider Demographics
NPI:1679586945
Name:COVENANT HOME SERVICES, LLC
Entity Type:Organization
Organization Name:COVENANT HOME SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:KLINEFELTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-755-9009
Mailing Address - Street 1:11375 ROBINSON DR NW
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2590
Mailing Address - Country:US
Mailing Address - Phone:763-755-9009
Mailing Address - Fax:763-862-8030
Practice Address - Street 1:11375 ROBINSON DR NW
Practice Address - Street 2:SUITE 104
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2590
Practice Address - Country:US
Practice Address - Phone:763-755-9009
Practice Address - Fax:763-862-8030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN332466251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN247089Medicare ID - Type Unspecified