Provider Demographics
NPI:1861582595
Name:COVENANT HOME CARE
Entity type:Organization
Organization Name:COVENANT HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LEVENGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, RN
Authorized Official - Phone:800-726-8761
Mailing Address - Street 1:1223 POTTSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:SHOEMAKERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19555-1719
Mailing Address - Country:US
Mailing Address - Phone:800-726-8761
Mailing Address - Fax:570-385-5287
Practice Address - Street 1:1223 POTTSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:SHOEMAKERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19555-1719
Practice Address - Country:US
Practice Address - Phone:800-726-8761
Practice Address - Fax:570-385-5287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA712905251E00000X
PA159199251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1722OtherBLUE SHIELD PROVIDER NO.
PA30892OtherGEISINGER PROVIDER NUMBER
PAC397129OtherGATEWAY PROVIDER NUMBER
PA397129OtherBLUE CROSS PROVIDER NO.
PA100773957Medicaid
PA70354200OtherBLACK LUNG PROVIDER NO.
PA1007739570008Medicaid
PA1007739570007Medicaid
PA70354200OtherBLACK LUNG PROVIDER NO.