# COVENANT PREMIUM SENIOR CARE

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

## Provider details

- **NPI number:** 1710348370
- **Authorized official:** DR. DERRICK JACKSON PHD (PRESIDENT & CHAIRMAN)
- **Authorized official phone:** (281) 394-9217

## Contact information

- **Practice address:** 28307 SUGARSIDE GLEN DR, KATY, TX 77494-1480
- **Practice address phone:** (281) 394-9217
- **Practice address fax:** (281) 394-9216
- **Mailing address:** 2918 CHAPEL ROCK, KATY, TX 77494-5256
- **Mailing address phone:** (281) 394-9217
- **Mailing address fax:** (281) 394-9216

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 03/10/2016
- **Last updated:** 01/10/2017