Organization
TRINITY MISSION HEALTH & REHAB OF HOLLY, LP
Active
Parent organization
COVENANT DOVE, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
COVENANT DOVE, LLC
Authorized official
MRS. JUDY ULLERY (PRESIDENT)
(901) 937-7994
Entity
Organization
Contact information
Practice address
2105 12TH AVE RD, NAMPA, ID 83686-6312
(208) 467-5721
(208) 467-2748
Mailing address
2105 12TH AVE RD, NAMPA, ID 83686-6312
(208) 467-5721
(208) 467-2748
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
29
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A227401
—
ID
Enumeration date
05/12/2006
Last updated
04/10/2008
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