Provider Demographics
NPI:1720415615
Name:COVENANT SENIOR DAY PROGRAM
Entity Type:Organization
Organization Name:COVENANT SENIOR DAY PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KURLOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-324-3250
Mailing Address - Street 1:7211 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4151
Mailing Address - Country:US
Mailing Address - Phone:269-324-3250
Mailing Address - Fax:269-321-0202
Practice Address - Street 1:7211 OAKLAND DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4151
Practice Address - Country:US
Practice Address - Phone:269-324-3250
Practice Address - Fax:269-321-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health