Provider Demographics
NPI:1841354974
Name:COVENANT HOSPICE INC
Entity type:Organization
Organization Name:COVENANT HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:O
Authorized Official - Last Name:KNEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-433-2155
Mailing Address - Street 1:5041 N 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8916
Mailing Address - Country:US
Mailing Address - Phone:850-433-2155
Mailing Address - Fax:850-202-5819
Practice Address - Street 1:3201 DAUPHIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4057
Practice Address - Country:US
Practice Address - Phone:251-478-8671
Practice Address - Fax:251-478-6931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALE4910251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL012-506OtherBLUE CROSS BLUE SHIELD
ALPIC1011EMedicaid
ALPIC1011EMedicaid
AL=========-009OtherTRICARE