Covenant Care Midwest, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0042846 Issued in IL

Legal business name

COVENANT CARE MIDWEST, INC

Doing business as

Friendship Home

Practice address

826 N High St
Carlinville, IL 62626-1165

Phone

(217) 854-9606

Fax

(217) 854-8484

NPI assigned

Oct 3, 2005

Last updated

Oct 24, 2008By 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

Carol Sparks

Title

Director of Reimbursement

Phone

(949) 349-1200

Specialties & licenses 1

Addresses

Other names 1

• Friendship Home Doing business as

Member of 1

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

• Covenant Care California, LLC

  dba Royal Care Skilled Nursing Center

  • 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": "1128297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224806400000",
    "number": "1558358804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "826 N HIGH ST",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626261165",
            "telephone_number": "217-854-9606",
            "fax_number": "217-854-8484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "826 N HIGH ST",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626261165",
            "telephone_number": "217-854-9606",
            "fax_number": "217-854-8484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT CARE MIDWEST, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-03",
        "last_updated": "2008-10-24",
        "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": "IL",
            "license": "0042846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Friendship Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alexander Chipman, LPC
• Changryol Choi, ATC
• Kamal K Chopra, MD
• Crystal Corso, LPC
• Cottages at Carlinville, Inc
• Makinze DC Cox
• Lourdes M Cruz, MD
• Hannah Marie Davidson, LCPC
• Peter Gordon Denby, DDS
• Parth Desai

• Skilled Nursing Facility in Carlinville, IL
• Providers in Carlinville, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2008; 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.