Provider Demographics
NPI:1730301979
Name:COVENANT HOME SERVICES
Entity Type:Organization
Organization Name:COVENANT HOME SERVICES
Other - Org Name:COVENANTCARE AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAUGHNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-845-0680
Mailing Address - Street 1:3755 E MAIN ST
Mailing Address - Street 2:SUITE 165
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2463
Mailing Address - Country:US
Mailing Address - Phone:630-845-0680
Mailing Address - Fax:630-444-1688
Practice Address - Street 1:3755 E MAIN ST
Practice Address - Street 2:SUITE 165
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2463
Practice Address - Country:US
Practice Address - Phone:630-845-0680
Practice Address - Fax:630-444-1688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4000133251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4521270OtherBLUE CROSS BLUE SHIELD