Provider Demographics
NPI:1871191221
Name:COVENANT HOME HEALTH LLC
Entity type:Organization
Organization Name:COVENANT HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-443-5487
Mailing Address - Street 1:11830 N. 19TH AVE
Mailing Address - Street 2:SUITE 101 PENDLETON
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029
Mailing Address - Country:US
Mailing Address - Phone:602-443-5447
Mailing Address - Fax:602-424-9447
Practice Address - Street 1:11830 N. 19TH AVE
Practice Address - Street 2:SUITE 101 PENDLETON
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029
Practice Address - Country:US
Practice Address - Phone:602-443-5447
Practice Address - Fax:602-424-9447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care