Provider Demographics
NPI:1780800193
Name:COVENANT COMPASSIONATE CARE, INC.
Entity type:Organization
Organization Name:COVENANT COMPASSIONATE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:816-364-2600
Mailing Address - Street 1:2400 FREDERICK AVE
Mailing Address - Street 2:507
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2758
Mailing Address - Country:US
Mailing Address - Phone:816-364-2600
Mailing Address - Fax:816-364-2687
Practice Address - Street 1:2400 FREDERICK AVE
Practice Address - Street 2:507
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2758
Practice Address - Country:US
Practice Address - Phone:816-364-2600
Practice Address - Fax:816-364-2687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO764-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health