Provider Demographics
NPI:1861226680
Name:COVENANT CARE LLC
Entity type:Organization
Organization Name:COVENANT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALAT
Authorized Official - Middle Name:
Authorized Official - Last Name:ANYAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-703-1047
Mailing Address - Street 1:41 HUTCHINS DR BUILDING 3 1ST AND 2ND FLOOR STE UL-17
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102
Mailing Address - Country:US
Mailing Address - Phone:651-703-1047
Mailing Address - Fax:
Practice Address - Street 1:41 HUTCHINS DR BUILDING 3 1ST AND 2ND FLOOR STE UL-17
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:651-703-1047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care