Covenant Care Lodi, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

397004353 Issued in CA

Legal business name

COVENANT CARE LODI, LLC

Practice address

17 Louie Ave
Lodi, CA 95240-1283

Phone

(209) 369-8282

Fax

(209) 369-7638

NPI assigned

Nov 30, 2010

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 names 1

• Arbor Place Doing business as

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

{
    "created_epoch": "1291075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291075200000",
    "number": "1477855286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 LOUIE AVE",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952401283",
            "telephone_number": "209-369-8282",
            "fax_number": "209-369-7638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 LOUIE AVE",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952401283",
            "telephone_number": "209-369-8282",
            "fax_number": "209-369-7638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT CARE LODI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-30",
        "last_updated": "2010-11-30",
        "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": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "397004353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arbor Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Costco Wholesale Corporation
• Costco Wholesale Corporation
• Costco Wholesale Corporation
• Jesus David Covarrubias
• Covenant Care Lodi, LLC
• Kiana Lee Nicole Cox, MD
• Hannah Renee Cronin, RT1431260226
• Kristine Csicsery, PT
• Kirsten M Culler, MD
• Alexander J Curfman, DPM

• Assisted Living Facility in Lodi, CA
• Providers in Lodi, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2010; 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.