Provider Demographics
NPI:1851046353
Name:COVENANT CARE HEALTH SERVICES, LLC.
Entity Type:Organization
Organization Name:COVENANT CARE HEALTH SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:901-230-6886
Mailing Address - Street 1:5551 ROSS RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-0445
Mailing Address - Country:US
Mailing Address - Phone:901-230-6886
Mailing Address - Fax:
Practice Address - Street 1:5551 ROSS RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-0445
Practice Address - Country:US
Practice Address - Phone:901-230-6886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty