Provider Demographics
NPI:1255603379
Name:COVENANT CONTRACT SERVICE
Entity type:Organization
Organization Name:COVENANT CONTRACT SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:FANCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-510-1933
Mailing Address - Street 1:3939 S CHARLESTON PIKE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-8385
Mailing Address - Country:US
Mailing Address - Phone:888-510-1933
Mailing Address - Fax:888-510-1932
Practice Address - Street 1:3939 S CHARLESTON PIKE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-8385
Practice Address - Country:US
Practice Address - Phone:888-510-1933
Practice Address - Fax:888-510-1932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-05
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHMER23319332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1203549Medicaid
OH557476OtherJOINT COMMISSION ACCREDITATION
OHHMER 23319OtherOHIO RESPIRATORY CARE BOARD
OH0052155Medicaid
OH557476OtherJOINT COMMISSION ACCREDITATION