Organization
COVENANT HEALTHCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OLUMIDE JOHNSON CNA (COO)
(951) 330-6236
Entity
Organization
Contact information
Practice address
1692 S SANTA FE AVE, 62, SAN JACINTO, CA 92583-5067
(951) 330-6236
(951) 654-8639
Mailing address
1692 S SANTA FE AVE, 62, SAN JACINTO, CA 92583-5067
(951) 330-6236
(951) 654-8639
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
00240076
CA
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
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