Covenant Care California, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

020000123 Issued in CA

Legal business name

COVENANT CARE CALIFORNIA, LLC

Practice address

2124 57TH Avenue
Oakland, CA 94621-4322

Phone

(510) 261-2628

Fax

(510) 261-5483

NPI assigned

Feb 13, 2007

Organization subpart

No

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

Authorized official

Name

Carol Sparks

Title

Director of Reimbursement

Phone

(949) 349-1200

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Willow Tree Nursing Center Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Covenant Care California, LLC

  • Skilled Nursing Facility
  • Long Beach, CA
  • NPI 1053453902

  Member Of

  NPD member

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391385600000",
    "number": "1346382298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2124 57TH AVENUE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946214322",
            "telephone_number": "510-261-2628",
            "fax_number": "510-261-5483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2124 57TH AVENUE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946214322",
            "telephone_number": "510-261-2628",
            "fax_number": "510-261-5483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT CARE CALIFORNIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2014-02-03",
        "status": "A",
        "authorized_official_last_name": "SPARKS",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "DIRECTOR OF REIMBURSEMENT",
        "authorized_official_telephone_number": "949-349-1200"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "020000123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZR05876I",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OSHPD",
            "identifier": "206010995",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Tree Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicole Danielle Coutu
• Marlene Ann Couvson
• Cheyenne Covarrubias
• Rosana Covarrubias
• Daniel McCarthy Covel
• Covia Communities
• Ally Covino
• Brandon Ellis Cowan, MD
• Kathleen Marie Cowan, LMFT
• Kirsten Cowan, L.AC

• Skilled Nursing Facility in Oakland, CA
• Providers in Oakland, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2014; 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.