Provider Demographics
NPI:1871826693
Name:COVENANT HOME HEALTH CARE L.L.C
Entity Type:Organization
Organization Name:COVENANT HOME HEALTH CARE L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:UGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-465-9123
Mailing Address - Street 1:5109 W BROAD ST STE 205
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1648
Mailing Address - Country:US
Mailing Address - Phone:614-645-9123
Mailing Address - Fax:
Practice Address - Street 1:5109 W BROAD ST STE 205
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1648
Practice Address - Country:US
Practice Address - Phone:614-645-9123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1881796251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3094388Medicaid
OH36-8329OtherMEDICARE