NPIMap

Organization Active NPI

Covenant Home Services

Doing business as CovenantCare at Home

  • Home Health Agency
  • St Charles, IL
National Provider Identifier
1679794143
Registry record updated Jul 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
1011067 Issued in IL
Legal business name
COVENANT HOME SERVICES
Doing business as
CovenantCare at Home
Practice address
3755 East Main Street
Suite 165
St Charles, IL 60174
Phone
(630) 845-0680
Fax
(630) 845-0685
NPI assigned
May 1, 2007
Last updated
Jul 6, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2016

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

Authorized official

Name
Ms. Elizabeth Malzahn
Title
Vice President of Health Services
Phone
(773) 878-4430

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 1011067 IL Primary

Addresses

Primary practice location

3755 East Main Street
Suite 165
St Charles, IL 60174

Mailing address

3755 E Main St Ste 165
St Charles, IL 60174-2409
Phone (630) 845-0680

Other names 1

  • CovenantCare at Home Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090209000483 IL Part A Provider - Home Health Agency 4688740582 Practice locations: St Charles, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679794143. Details of each certification follow.

Home health agency certification: CCN 147618

Legal name
COVENANT HOME SERVICES
Doing business as
COVENANTCARE AT HOME
Certification status
Active
Provider type (POS)
Home health agency
Participating since
May 23, 1995
Last certification
Dec 20, 2018
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Aug 7, 2007 in IL
Enrollment address
3755 East Main Street
Suite 165
St Charles, IL 60174-2463

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Covenantcare at HomeCCN 147618 · All quality measures
Overall star rating
4 of 5
Ownership
Non-Profit
Certified
May 23, 1995
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Covenanthome Services7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Covenant Living Communities & Services Organization, Skokie, IL Non-profit Operational/Managerial Control Dec 23, 1975
Janet S Creaney Individual Corporate OfficerVice Chair Jul 24, 2020
Covenant Home Services Organization, St Charles, IL 5% Or Greater Direct Ownership Interest Aug 7, 2007 100%
Operational/Managerial Control Sep 25, 2008
Elizabeth Malzahn Individual Corporate OfficerVP of Reimbursement Jun 5, 2019
Corporate DirectorVP of Reimbursement Jun 5, 2019
W-2 Managing EmployeeVP of Reimbursement Jun 5, 2019
Terri Cunliffe Individual Corporate OfficerCeo May 22, 2015
W-2 Managing EmployeeCeo May 22, 2015
Operational/Managerial ControlCeo May 22, 2015
Jeannie Justie Individual Corporate OfficerCfo Sep 20, 2020
W-2 Managing EmployeeCfo Sep 20, 2020
Operational/Managerial ControlCfo Sep 20, 2020
Matt Manlove Individual Corporate OfficerBoard Chair Jul 1, 2020
Teresa R Felder Individual W-2 Managing EmployeeAdministrator Aug 1, 2016
Lorene G Flewellen Individual Corporate OfficerSecretary Apr 29, 2022

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Covenant Home Services

    dba CovenantCare Hospice

    • Community Based Hospice Care Agency
    • St Charles, IL
    • NPI 1952615809

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covenant Home Services

    dba ConvenantCare at Home

    • Home Health Agency
    • Turlock, CA
    • NPI 1538251525

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Covenant Home Services

    dba CovenantCare Hospice

    • Community Based Hospice Care Agency
    • Turlock, CA
    • NPI 1740626829

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Covenantcare HospiceSt. Charles, IL, CCN 141639 Hospice 5% Or Greater Direct Ownership Interest May 6, 2011

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 17

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 17

Practitioners & affiliated clinicians

Affiliated clinicians 23

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467763200000",
    "number": "1679794143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3755 E MAIN ST STE 165",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742409",
            "telephone_number": "630-845-0680",
            "fax_number": "630-845-0685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3755 EAST MAIN STREET",
            "address_2": "SUITE 165",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "60174",
            "telephone_number": "630-845-0680",
            "fax_number": "630-845-0685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT HOME SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2016-07-06",
        "status": "A",
        "authorized_official_last_name": "MALZAHN",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "VICE PRESIDENT OF HEALTH SERVICES",
        "authorized_official_telephone_number": "773-878-4430",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IL",
            "license": "1011067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CovenantCare at Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Charles, IL

Sources for this page

Verify at the official NPI Registry.