Provider Demographics
NPI:1760846034
Name:COVENANT HEALTH SERVICES
Entity Type:Organization
Organization Name:COVENANT HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MONTEILH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-725-0667
Mailing Address - Street 1:2730 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MENTONE
Mailing Address - State:CA
Mailing Address - Zip Code:92359-9807
Mailing Address - Country:US
Mailing Address - Phone:909-725-0667
Mailing Address - Fax:
Practice Address - Street 1:2730 MILL CREEK RD
Practice Address - Street 2:
Practice Address - City:MENTONE
Practice Address - State:CA
Practice Address - Zip Code:92359-9807
Practice Address - Country:US
Practice Address - Phone:909-725-0667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360092AN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility