Covenant Community Care, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

4704195855 Issued in MI

Legal business name

COVENANT COMMUNITY CARE, INC.

Practice address

27776 Woodward Ave
Royal Oak, MI 48067-0930

Phone

(248) 556-4900

Fax

(248) 556-4950

NPI assigned

Jun 16, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Joslyn Pettway

Title

Chief Executive Officer

Phone

(313) 554-0485

Specialties & licenses 1

Addresses

Other names 1

• Covenant Woodward Avenue Other name

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19800/brand/1/csg/1/fhir/r4

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652832000000",
    "number": "1073834818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "559 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482162200",
            "telephone_number": "313-554-0485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27776 WOODWARD AVE",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480670930",
            "telephone_number": "248-556-4900",
            "fax_number": "248-556-4950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT COMMUNITY CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-16",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A",
        "authorized_official_last_name": "PETTWAY",
        "authorized_official_first_name": "JOSLYN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "313-554-0485",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MI",
            "license": "4704195855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Covenant Woodward Avenue",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Covenant Woodward Avenue",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Colleen L Cotter, PA-C
• Michael Cottone
• Danielle Marie Coulson, DNP
• Counseling Solutions, LLC
• Craig Cousineau, DO, MPH
• Stuart Covi, M.D.
• Samantha Rene Cowing, MD
• Clarissa C Cowles, MD
• James Cox
• Matthew Cox, PT, DPT

• Federally Qualified Health Center (FQHC) in Royal Oak, MI
• Providers in Royal Oak, MI by specialty
• Federally Qualified Health Center (FQHC) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.