Provider Demographics
NPI:1982690640
Name:COVENANT HOMECARE
Entity Type:Organization
Organization Name:COVENANT HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-374-0600
Mailing Address - Street 1:3001 LAKE BROOK BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1100
Mailing Address - Country:US
Mailing Address - Phone:865-374-0600
Mailing Address - Fax:865-374-2061
Practice Address - Street 1:3001 LAKE BROOK BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1100
Practice Address - Country:US
Practice Address - Phone:865-374-0600
Practice Address - Fax:865-374-2061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000133251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0152215OtherBLUE CROSS AND BLUE SHIEL
TN5467111OtherAETNA
TN070036899OtherEEOICPA
TN100020430Medicaid
TN702002087OtherCARITEN
TN7773468OtherAETNA MORRISTOWN OFFICE
TN100020430Medicaid
TN100020430Medicaid