Organization
COVENANT HOME HEALTH CARE SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAMELA DIANE MITCHELL (PRESIDENT)
(304) 757-9333
Entity
Organization
Contact information
Practice address
109 POPLAR FORK RD, SUITE B, SCOTT DEPOT, WV 25560-9766
(304) 757-9333
(304) 757-9336
Mailing address
109 POPLAR FORK RD, SUITE B, SCOTT DEPOT, WV 25560-9766
(304) 757-9333
(304) 757-9336
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
WV404123
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2784803
—
OH
05
—
3810006368
—
WV
01
—
WV404123
STATE PROVIDER ID NUMBER
WV
Enumeration date
08/05/2006
Last updated
02/06/2012
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