Provider Demographics
NPI:1265514392
Name:COVENANT HOME CARE
Entity type:Organization
Organization Name:COVENANT HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LEVENGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, RN
Authorized Official - Phone:800-726-8761
Mailing Address - Street 1:1223 POTTSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:SHOEMAKERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19555-1719
Mailing Address - Country:US
Mailing Address - Phone:800-726-8761
Mailing Address - Fax:570-385-5287
Practice Address - Street 1:1223 POTTSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:SHOEMAKERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19555-1719
Practice Address - Country:US
Practice Address - Phone:800-726-8761
Practice Address - Fax:570-385-5287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA159199251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA391591OtherKEYSTONE HOSPICE PROV.NO.
PA1838OtherBLUE SHIELD HOSPICE PROV.
PA86900OtherGEISINGER HOSPICE PROV.NO
PA1007739570004Medicaid
PA391591OtherBLUE CROSS HOSPICE PROV.
PA100773957Medicaid
PA1007739570005Medicaid
PA39-1591Medicare UPIN