Provider Demographics
NPI:1871823955
Name:COVENANT CARE SERVICES, LLC
Entity Type:Organization
Organization Name:COVENANT CARE SERVICES, LLC
Other - Org Name:ASHLEY'S PLACE ADULT DAY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:REAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-783-6256
Mailing Address - Street 1:PO BOX 110
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-0110
Mailing Address - Country:US
Mailing Address - Phone:573-783-6256
Mailing Address - Fax:573-783-8148
Practice Address - Street 1:1610 W. HWY 72
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645
Practice Address - Country:US
Practice Address - Phone:573-783-6256
Practice Address - Fax:573-783-8148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO864311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home