Covenant Care Services, LLC

NPI #1114276029 in Salem, Missouri

Provider Information

NPI Number: 1114276029
Entity Type: Organization
Organization Name: Covenant Care Services, LLC
Subpart: Yes (part of a larger organization)
Parent Organization: COVENANT CARE SERVICES, LLC
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Sep 6, 2012
Last Updated: Sep 10, 2012

Practice Location

Address: 407 E 4TH ST
City: Salem
State: Missouri
ZIP Code: 65560-1547
Phone: (573) 783-6256

Authorized Official

Name: MR. WARREN KEITH REAGAN
Title: OWNER
Phone: (573) 783-6256

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Custodial Care Facility - Adult Care Home — Adult Care Home	311ZA0620X
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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