Covenant Care Ohio, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1624NH Issued in OH

Legal business name

COVENANT CARE OHIO, INC.

Practice address

1330 Fulton St
Port Clinton, OH 43452-9297

Phone

(419) 734-5506

Fax

(419) 734-2384

NPI assigned

Oct 6, 2005

Organization subpart

No

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

Authorized official

Name

Carol A Sparks

Title

Director of Reimbursement

Phone

(949) 349-1200

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Edgewood Manor Nursing Center Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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": "1128556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225152000000",
    "number": "1497743256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 FULTON ST",
            "city": "PORT CLINTON",
            "state": "OH",
            "postal_code": "434529297",
            "telephone_number": "419-734-5506",
            "fax_number": "419-734-2384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 FULTON ST",
            "city": "PORT CLINTON",
            "state": "OH",
            "postal_code": "434529297",
            "telephone_number": "419-734-5506",
            "fax_number": "419-734-2384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT CARE OHIO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-06",
        "last_updated": "2008-10-28",
        "status": "A",
        "authorized_official_last_name": "SPARKS",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "A",
        "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": "OH",
            "license": "1624NH",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2056304",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edgewood Manor Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tonia Marie Copsey, CNP
• Cornerstone Caregiving East LLC
• County of Ottawa
• County of Ottawa
• Kimberly Courtney
• Barry Reed Cover, M.D.
• Breanne Crawford
• Emma Rose Crawford
• Haley Crawford
• Guillermo V Crisologo, M.D.

• Skilled Nursing Facility in Port Clinton, OH
• Providers in Port Clinton, OH by specialty
• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.