Provider Demographics
NPI:1912958364
Name:COVENANT HOME CARE LLC
Entity Type:Organization
Organization Name:COVENANT HOME CARE LLC
Other - Org Name:COVENANT HOME CARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-593-6177
Mailing Address - Street 1:133 WEST LONG LAKE ROAD
Mailing Address - Street 2:STE 150
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302
Mailing Address - Country:US
Mailing Address - Phone:248-593-6177
Mailing Address - Fax:248-593-6002
Practice Address - Street 1:1133 W LONG LAKE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-1983
Practice Address - Country:US
Practice Address - Phone:248-593-6177
Practice Address - Fax:248-593-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4988105Medicaid
MI4988105Medicaid