Provider Demographics
NPI:1861525768
Name:COVENANT HEALTHCARE LLC
Entity type:Organization
Organization Name:COVENANT HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMEY
Authorized Official - Suffix:
Authorized Official - Credentials:ATTORNEY
Authorized Official - Phone:252-791-0083
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NC
Mailing Address - Zip Code:27962-0186
Mailing Address - Country:US
Mailing Address - Phone:252-791-0083
Mailing Address - Fax:252-791-0086
Practice Address - Street 1:115 E WATER ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-1329
Practice Address - Country:US
Practice Address - Phone:252-791-0083
Practice Address - Fax:252-791-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3175251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418332Medicaid