Provider Demographics
NPI:1205076445
Name:COVENANT IN HOME SERVICES LLC
Entity type:Organization
Organization Name:COVENANT IN HOME SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DESIGNATED MANAGER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRELL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SIMMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-361-1935
Mailing Address - Street 1:8227 PAGE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-1116
Mailing Address - Country:US
Mailing Address - Phone:314-890-0025
Mailing Address - Fax:314-890-0194
Practice Address - Street 1:224 ABINGTON DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-8180
Practice Address - Country:US
Practice Address - Phone:636-978-0933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-28
Last Update Date:2009-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care