Covenant Independent Living Services, Inc.

Primary specialty

Personal Care AttendantTaxonomy code 3747P1801X

Legal business name

COVENANT INDEPENDENT LIVING SERVICES, INC.

Practice address

601 NW 5TH St
Brainerd, MN 56401-2963

Phone

(218) 824-0615

NPI assigned

Oct 25, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shelly Dawn Johnson

Title

Director

Phone

(218) 824-0615

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1336223114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 NW 5TH ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564012963",
            "telephone_number": "218-824-0615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 NW 5TH ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564012963",
            "telephone_number": "218-824-0615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT INDEPENDENT LIVING SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "218-824-0615"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Personal Care Attendant in Brainerd, MN
• Providers in Brainerd, MN by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.