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Organization

COVENANT CONNECTIONS HOME CARE, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. BETTY JOYCE INGRAM RN (CEO)
(313) 592-1517
Entity
Organization

Contact information

Practice address
18440 W MCNICHOLS RD, DETROIT, MI 48219-4161
(313) 592-1517
(313) 592-1530
Mailing address
18440 W MCNICHOLS RD, DETROIT, MI 48219-4161
(313) 592-1517
(313) 592-1530

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1376687897
OMNICARE
MI
01
23-7776
MEDICARE PTAN
MI
01
IE911
BLUE CROSS/BLUE SHEILD
MI
Enumeration date
02/17/2007
Last updated
03/05/2012
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