Covenant Hospice Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

5025095 Issued in FL

Legal business name

COVENANT HOSPICE INC

Practice address

3383 S Ferdon Blvd # B-5
Crestview, FL 32536-8484

Phone

(850) 682-3628

Fax

(850) 682-8434

NPI assigned

Dec 26, 2006

Last updated

Oct 10, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

COVENANT HOSPICE INCAs reported in NPPES

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

Authorized official

Name

Mr. Roland Cleneay

Title

Cfo

Phone

(850) 433-2155

Specialties & licenses 1

Addresses

Other identifiers 2

Part of

Covenant Hospiceinc

Locations

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633824000000",
    "number": "1194880690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5041 N 12TH AVE",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325048916",
            "telephone_number": "850-433-2155",
            "fax_number": "850-202-5819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3383 S FERDON BLVD # B-5",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325368484",
            "telephone_number": "850-682-3628",
            "fax_number": "850-682-8434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT HOSPICE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COVENANT HOSPICE INC",
        "enumeration_date": "2006-12-26",
        "last_updated": "2021-10-10",
        "certification_date": "2021-10-10",
        "status": "A",
        "authorized_official_last_name": "CLENEAY",
        "authorized_official_first_name": "ROLAND",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "850-433-2155",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "FL",
            "license": "5025095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "087517100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "U20",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community Based Hospice Care Agency in Crestview, FL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2021; 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.