Organization · Type 2 NPI

Covenant Care Services, LLC

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Salem, MO

NPI number 1114276029 Active

Practice location

407 E 4th St
Salem, MO 65560-1547

Call (573) 783-6256 Map

Fax (573) 783-8148

Mailing address

PO Box 110
Fredericktown, MO 63645-0110

Specialties and licenses

Taxonomy	Code	License
Adult Care Home Facility	311ZA0620X	1008 (MO)
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary	320900000X	1008 (MO)

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.

NPI record

NPI: 1114276029
Entity type: Organization (Type 2)
Issued: Sep 6, 2012
Last updated: Sep 10, 2012
Status: Active
Subpart: Yes of Covenant Care Services, LLC

Other names

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Ashley's Place Adult Day Care · doing business as

Authorized official

Mr. Warren Keith Reagan
Owner
(573) 783-6256

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1114276029

Covenant Care Services, LLC's National Provider Identifier is 1114276029, issued on Sep 6, 2012. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in Salem, MO. The record was last updated on Sep 10, 2012.