Provider Demographics
NPI:1396742805
Name:COVENANT HOSPICE & PALLIATIVE CARE, LP
Entity type:Organization
Organization Name:COVENANT HOSPICE & PALLIATIVE CARE, LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:CAPPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-735-8741
Mailing Address - Street 1:3221 COLLINSWORTH ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6577
Mailing Address - Country:US
Mailing Address - Phone:817-735-8741
Mailing Address - Fax:817-735-8836
Practice Address - Street 1:3221 COLLINSWORTH ST
Practice Address - Street 2:STE 160
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6577
Practice Address - Country:US
Practice Address - Phone:817-735-8741
Practice Address - Fax:817-735-8836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007583251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001003206Medicaid
TX007583OtherHCSSA STATE LICENSE #
TX007583OtherHCSSA STATE LICENSE #