Provider Demographics
NPI:1134541725
Name:COVENANT BPEY HOLDINGS, LLC
Entity type:Organization
Organization Name:COVENANT BPEY HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:YEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SONAIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-826-3883
Mailing Address - Street 1:806 TOWNE PARK DR STE 100
Mailing Address - Street 2:P. O. BOX 1082
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-9369
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:806 TOWNE PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-9369
Practice Address - Country:US
Practice Address - Phone:912-826-3883
Practice Address - Fax:866-492-2196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA671861833CMedicaid
GA671861833AMedicaid