Covington House of Raleigh,LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

HAL-092-121 Issued in NC

Legal business name

COVINGTON HOUSE OF RALEIGH,LLC

Doing business as

Pine Tree Villa

Practice address

4510 Duraleigh Rd
Raleigh, NC 27612-3534

Phone

(919) 791-1981

Fax

(919) 791-1986

NPI assigned

Nov 25, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Charlie E Trefzger Jr.

Title

Manager

Phone

(828) 324-8898

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pine Tree Villa Doing business as

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

{
    "created_epoch": "1164412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205902079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1978 8TH AVE NW",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286013312",
            "telephone_number": "828-324-8898",
            "fax_number": "828-322-9587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4510 DURALEIGH RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276123534",
            "telephone_number": "919-791-1981",
            "fax_number": "919-791-1986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVINGTON HOUSE OF RALEIGH,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TREFZGER",
        "authorized_official_first_name": "CHARLIE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "828-324-8898",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL-092-121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805597",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Tree Villa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Covenant Care Community Service Inc
• Covenant Community Partners LLC
• Winona Coveney, LCSWA
• Kelli Mack Covert, CRNA
• Elizabeth Coviello, DO
• Ashley Covington, MS
• Connell Covington, M.D.
• Shenita Covington
• Sherrill Covington, MA, LPCA
• Suzanne Steele Covington, M.D.

• Assisted Living Facility in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Assisted Living Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.