Covenant Care LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2073 Issued in WI

Legal business name

COVENANT CARE LLC

Doing business as

Fall Creek Valley Care Center

Practice address

344 W Lincoln Ave
Fall Creek, WI 54742-9397

Phone

(715) 877-2411

Fax

(715) 877-2416

NPI assigned

Jun 10, 2005

Organization subpart

No

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

Authorized official

Name

Mr. John Charles Halbleib

Title

Administrator

Phone

(715) 877-2411

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Fall Creek Valley Care Center Doing business as

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245234897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 398",
            "city": "FALL CREEK",
            "state": "WI",
            "postal_code": "547420398",
            "telephone_number": "715-877-2411",
            "fax_number": "715-877-2416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "344 W LINCOLN AVE",
            "city": "FALL CREEK",
            "state": "WI",
            "postal_code": "547429397",
            "telephone_number": "715-877-2411",
            "fax_number": "715-877-2416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HALBLEIB",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "715-877-2411",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "2073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20190400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fall Creek Valley Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Matthew Thomas Anderson, DDS
• Angela Rae Barribeau
• Katharine Borreson
• Colette S. Cline, RDH
• Daniel Cook, RN
• Virginia Carol Duerst, PHD
• Enigma Psychological Inc.
• Fall Creek Chiropractic Inc.
• Fall Creek Dental
• Fall Creek Family Dental, LLC

• Skilled Nursing Facility in Fall Creek, WI
• Providers in Fall Creek, WI by specialty
• Skilled Nursing Facility in Wisconsin

• 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.