COVENANT CARE SERVICES, LLC (NPI# 1114276029) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114276029 |
| Entity Type | Organization |
| Organization Name | COVENANT CARE SERVICES, LLC |
| Other Organization Name | ASHLEY'S PLACE ADULT DAY CARE |
| Practice Address |
407 E 4th St Salem MO 65560-1547 |
| Mailing Address |
Po Box 110 Fredericktown MO 63645-0110 |
| Practice Telephone | 5737836256 |
| Practice Fax Number | 5737838148 |
| Mailing Telephone | 5737836256 |
| Mailing Fax Number | 5737838148 |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2012-09-10 |
| Authorized Official Name | MR. WARREN KEITH REAGAN (OWNER) |
| Authorized Official Telephone | 5737836256 |
| Is Organization Subpart | Y |
| Parent Organization Name | COVENANT CARE SERVICES, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
1008 | MO | Nursing & Custodial Care Facilities |
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1008 | MO | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 1487749537 | 05 | |
| MO | 1871823955 | 05 | |
| MO | 1245370808 | 05 | |
| MO | 1770623266 | 05 | |
| MO | 1326188996 | 05 |
| Other Name | Type Code |
|---|---|
| Ashley's Place Adult Day Care | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871823955 | Covenant Care Services, LLC | Custodial Care Facility | 1610 W. Hwy 72, Fredericktown, MO 63645 | 2010-01-12 |
| 1245370808 | Covenant Care Services, LLC | Day Training/Habilitation Specialist | 120 S Mine La Motte St, Fredericktown, MO 63645-1229 | 2007-02-06 |
| 1487749537 | Covenant Care Services, LLC | Registered Nurse | 120 S. Mine Lamotte, Fredericktown, MO 63645 | 2006-10-04 |
| 1770623266 | Covenant Care Services, LLC | Registered Nurse | 120 S Mine La Motte St, Fredericktown, MO 63645-1229 | 2007-02-07 |
| 1326188996 | Covenant Care Services, LLC | Chore Provider | 120 S Mine La Motte St, Fredericktown, MO 63645-1229 | 2007-02-06 |
| Street Address |
407 E 4TH ST |
| City | SALEM |
| State | MO |
| Zip Code | 65560-1547 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174087985 | Brenda Gott | Nurse Practitioner | 3103 Hh Highway, Salem, MO 65560 | 2019-01-25 |
| 1174959142 | Britney Nicole Christesen | Chiropractor | 909 S Pershing Ave, Salem, MO 65560 | 2013-09-22 |
| 1245550474 | Amber Nicole Duncan | Chiropractor | 803 W 32 Hwy, Suite B, Salem, MO 65560 | 2010-06-10 |
| 1043460371 | Tina Marie Mcmullin | Counselor | 601 East Center Street, Salem, MO 65560 | 2008-09-23 |
| 1225286347 | Craig Tatom | Nurse Practitioner | Hwy 72 N Physicians Office Building II, Salem, MO 65560 | 2008-09-03 |
| 1114190576 | Jamie Johnston Wilson | Registered Nurse | Hwy 72 West, Salem, MO 65560 | 2008-04-08 |
| 1750589024 | Vicky L Gulley | Emergency Medicine | 35629 Hwy 72, Pob 1, Suite 3, Salem, MO 65560 | 2007-07-06 |
| 1275669533 | Complete Care, Inc | Durable Medical Equipment & Medical Supplies | 116 W. 4th, Salem, MO 65560 | 2007-02-23 |
| 1023083722 | Brent K. Caudill | General Practice | Hwy 72 N, Salem, MO 65560 | 2006-02-17 |
| 1750369369 | Charles W Cunningham | Family Medicine | 1010 E Scenic Rivers Blvd, Salem, MO 65560 | 2006-01-04 |
| Find all providers in zip 65560 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750750071 | The Arc of Salem County | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 150 Salem Woodstown Rd, Salem, NJ 08079 | 2015-09-16 |
| 1598988834 | Blue River Services, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 118 N. Nichols Ave., Salem, IN 47167 | 2007-04-11 |
| 1740303973 | Blue River Services, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 75 E. Oak Dr, Salem, IN 47167 | 2007-04-10 |
| 1053486621 | Virginia Baptist Children's Home & Family Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 860 Mount Vernon Ln, Salem, VA 24153-2700 | 2006-11-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609475516 | Brandi Janelle Hickman | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8706 Newton Ave Apt 4101, Kansas City, MO 64138-5461 | 2020-10-21 |
| 1154935112 | Overcomers Counseling Center Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 17101 East 203rd St, Peculiar, MO 64078 | 2020-09-06 |
| 1386265965 | Candace Palmer | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2405 Bowe Ln, Jefferson City, MO 65109-9116 | 2020-05-05 |
| 1902426596 | Matt Ferguson | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4480 Bradley Dr, Joplin, MO 64804-5503 | 2020-04-23 |
| 1689206211 | Insight Industry LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2501 Ne Prairie Falcon Dr, Blue Springs, MO 64014-1958 | 2020-02-11 |
| 1598306904 | Hearo Technologies LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 405 N Jefferson Ave Ste 1063, Springfield, MO 65806-1110 | 2019-10-07 |
| 1437790219 | Darin Roark | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2628 Se Kimbrough Ln, Lees Summit, MO 64063-1082 | 2019-10-03 |
| 1942851399 | Wyatt's Dream Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 205 State Highway Aa, Sikeston, MO 63801-5303 | 2019-09-26 |
| 1043871908 | Cura Personalis, (care for The Whole Person), LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 11650 Bobwhite Road, Carthage, MO 64836 | 2019-06-21 |
| 1043870181 | Rebuild Contracting LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1783 Possum Hollow Dr, Camdenton, MO 65020-6709 | 2019-06-20 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on COVENANT CARE SERVICES, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.