Provider Demographics
NPI:1649540170
Name:COVENANT HOMECARE
Entity type:Organization
Organization Name:COVENANT HOMECARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-374-0602
Mailing Address - Street 1:3001 LAKE BROOK BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1100
Mailing Address - Country:US
Mailing Address - Phone:865-374-0600
Mailing Address - Fax:865-374-2061
Practice Address - Street 1:3001 LAKE BROOK BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1100
Practice Address - Country:US
Practice Address - Phone:865-374-0600
Practice Address - Fax:865-374-2061
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COVENANT HOMECARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-30
Last Update Date:2014-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000364163WH1000X, 363LC1500X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No163WH1000XNursing Service ProvidersRegistered NurseHospiceGroup - Multi-Specialty
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN195889OtherBLUE CROSS / BLUE SHIELD
TN7868433OtherAETNA
TN0152215Medicaid
TN195889OtherBLUE CROSS / BLUE SHIELD