NPIMap

Organization Active NPI

Covenant Care Services, LLC

Doing business as Ashley's Place Adult Day Care

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Salem, MO
National Provider Identifier
1114276029
Registry record updated Sep 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
1008 Issued in MO
Legal business name
COVENANT CARE SERVICES, LLC
Doing business as
Ashley's Place Adult Day Care
Practice address
407 E 4TH St
Salem, MO 65560-1547
Phone
(573) 783-6256
Fax
(573) 783-8148
NPI assigned
Sep 6, 2012
Last updated
Sep 10, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
COVENANT CARE SERVICES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 10, 2012

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

Authorized official

Name
Mr. Warren Keith Reagan
Title
Owner
Phone
(573) 783-6256

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X 1008 MO
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 1008 MO Primary

Addresses

Primary practice location

407 E 4TH St
Salem, MO 65560-1547

Mailing address

PO Box 110
Fredericktown, MO 63645-0110
Phone (573) 783-6256

Other identifiers 5

IdentifierTypeStateIssuer
1326188996MedicaidMO
1245370808MedicaidMO
1487749537MedicaidMO
1770623266MedicaidMO
1871823955MedicaidMO

Other names 1

  • Ashley's Place Adult Day Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Covenant Care Services LLC6 organizations share this tax ID, including this one
Part of
Covenant Care Services LLC

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

407 E 4th St
Salem, MO 65560
Phone (573) 783-6256

NPI Registry JSON

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

{
    "created_epoch": "1346889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347235200000",
    "number": "1114276029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 110",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636450110",
            "telephone_number": "573-783-6256",
            "fax_number": "573-783-8148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 E 4TH ST",
            "city": "SALEM",
            "state": "MO",
            "postal_code": "655601547",
            "telephone_number": "573-783-6256",
            "fax_number": "573-783-8148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT CARE SERVICES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COVENANT CARE SERVICES, LLC",
        "enumeration_date": "2012-09-06",
        "last_updated": "2012-09-10",
        "status": "A",
        "authorized_official_last_name": "REAGAN",
        "authorized_official_first_name": "WARREN",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-783-6256",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "MO",
            "license": "1008",
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MO",
            "license": "1008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326188996",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245370808",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1487749537",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1770623266",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871823955",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ashley's Place Adult Day Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salem, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2012; 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.