# COVENANT HEALTHCARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538506514
- **Authorized official:** MR. OLUMIDE JOHNSON CNA (COO)
- **Authorized official phone:** (951) 330-6236

## Contact information

- **Practice address:** 1692 S SANTA FE AVE, 62, SAN JACINTO, CA 92583-5067
- **Practice address phone:** (951) 330-6236
- **Practice address fax:** (951) 654-8639
- **Mailing address:** 1692 S SANTA FE AVE, 62, SAN JACINTO, CA 92583-5067
- **Mailing address phone:** (951) 330-6236
- **Mailing address fax:** (951) 654-8639

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | 00240076 | CA | Yes |
| 372500000X | Chore Provider | 00240076 | CA | — |
| 372600000X | Adult Companion | 00240076 | CA | — |
| 374U00000X | Home Health Aide | 00240076 | CA | — |
| 376K00000X | Nurse's Aide | 00767135 | CA | — |

## Other

- **Enumeration date:** 05/30/2013
- **Last updated:** 05/30/2013