COVENANT CARE, INC (NPI# 1639205925) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639205925 |
| Entity Type | Organization |
| Organization Name | COVENANT CARE, INC |
| Other Organization Name | WAGNER HEIGHTS RESIDENTIAL |
| Practice Address |
2435 Wagner Heights Rd Stockton CA 95209-1778 |
| Practice Telephone | 2094775353 |
| Practice Fax Number | 2094779959 |
| Mailing Telephone | 2094775353 |
| Mailing Fax Number | 2094779959 |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. MARIE ARBIOS (ADMINISTRATOR) |
| Authorized Official Telephone | 2094775353 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | CA | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | RCF00025F | 05 |
| Other Name | Type Code |
|---|---|
| WAGNER HEIGHTS RESIDENTIAL | Doing Business As Name - Organization |
| Street Address |
2435 WAGNER HEIGHTS RD |
| City | STOCKTON |
| State | CA |
| Zip Code | 95209-1778 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104272954 | William Luther Bennett | Pharmacist | 1131 Sunnyoak Way, Stockton, CA 95209 | 2016-05-11 |
| 1548686769 | Roland Rillamas Lagpacan | Pharmacist | 3131 West Hammer Lane, Stockton, CA 95209 | 2014-03-12 |
| 1346599677 | Luis Leyva Garcia | Marriage & Family Therapist | 1755 West Hammer Lane, Stockton, CA 95209 | 2012-08-31 |
| 1942506233 | Donna Lynn Peterson | Dentist | 9409 Thornton Rd, Stockton, CA 95209 | 2011-02-03 |
| 1386969798 | Miusotic Zaragoza | Social Worker | 1755 W. Hammer Lane Suite 8, Latino Behavioral Health, Stockton, CA 95209 | 2010-03-30 |
| 1497988844 | Marissa Elizabeth Preciado | Counselor | 10147 River Falls Cir, Stockton, CA 95209 | 2009-09-02 |
| 1316190796 | Sutter Gould Medical Foundation | Clinic/Center | 8011 Don Ave, Stockton, CA 95209 | 2008-10-29 |
| 1881845790 | Gary Earl Fiscus | Dentist | 4565 Quail Lakes Drive, Suite A-2, Stockton, CA 95209 | 2008-10-09 |
| 1326225665 | Shirley's Care Home Inc | Intermediate Care Facility, Mentally Retarded | 2330 Shropshire Dr, Stockton, CA 95209 | 2008-01-29 |
| 1134272727 | Joanie Mc Culloch | Homeopath | 8807 Thornton Rd, Ste. P, Stockton, CA 95209 | 2007-01-19 |
| Find all providers in zip 95209 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407489966 | Hollywood Rcfe, LLC | Assisted Living Facility | 2306 Hollywood Dr, Stockton, CA 95210-1626 | 2020-02-12 |
| 1942606108 | Brandon Lee Rose | Assisted Living Facility | 9207 Mammath Peak Cir, Stockton, CA 95212-3212 | 2014-11-14 |
| 1316354459 | Good Samaritan Carechoice & Compliance Group LLC | Assisted Living Facility | 5315 Barbados Cir, Stockton, CA 95210-6608 | 2014-07-22 |
| 1477809259 | Mgsact, Inc. | Assisted Living Facility | 517 East Fulton Street, Stockton, CA 95204-2227 | 2012-07-30 |
| 1619114881 | Stockton Heritage Partners, LLC | Assisted Living Facility | 3530 Deer Park Dr, Stockton, CA 95219-2350 | 2009-01-09 |
| 1083899660 | Country Palms Care Home | Assisted Living Facility | 2905 Bristol Ave, Stockton, CA 95204-3935 | 2008-01-02 |
| 1376723973 | Icare Manor, Inc. | Assisted Living Facility | 1215 W Swain Rd, Stockton, CA 95207-4228 | 2007-11-12 |
| 1982803961 | Villa Marche | Assisted Living Facility | 1119 Rose Marie Ln, Stockton, CA 95207 | 2007-07-11 |
| 1023225372 | Tru Health Inc | Assisted Living Facility | 2324 Lever Blvd, Stockton, CA 95206-2900 | 2007-05-17 |
| 1407997281 | Mgsact Inc | Assisted Living Facility | 517 E Fulton St, Stockton, CA 95204 | 2007-02-12 |
| Find all providers in STOCKTON | ||||
Please comment or provide details below to improve the information on COVENANT CARE, INC.
| 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.