Provider Demographics
NPI:1841808201
Name:COVENANT CARE HOME HEALTH AGENCY LLC
Entity type:Organization
Organization Name:COVENANT CARE HOME HEALTH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BACCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-371-6563
Mailing Address - Street 1:1005 S GLENDALE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-3203
Mailing Address - Country:US
Mailing Address - Phone:316-771-7315
Mailing Address - Fax:316-771-7319
Practice Address - Street 1:1005 S GLENDALE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3203
Practice Address - Country:US
Practice Address - Phone:316-771-7315
Practice Address - Fax:316-771-7319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health