Provider Demographics
NPI:1679901722
Name:COVENANT VENTURES TRANSPORTATION
Entity Type:Organization
Organization Name:COVENANT VENTURES TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SIJABULISO
Authorized Official - Middle Name:
Authorized Official - Last Name:MBURUMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-782-4256
Mailing Address - Street 1:3612 BENT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-7748
Mailing Address - Country:US
Mailing Address - Phone:972-782-4256
Mailing Address - Fax:
Practice Address - Street 1:3612 BENT RIDGE DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-7748
Practice Address - Country:US
Practice Address - Phone:972-782-4256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)