Covenant Care Ennoble, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

310764 Issued in IA

Legal business name

COVENANT CARE ENNOBLE, LLC

Doing business as

Ennoble Skilled Nursing and Rehabilitation Center

Practice address

2000 Pasadena Dr
Dubuque, IA 52001-0808

Phone

(563) 577-1076

Fax

(563) 584-0671

NPI assigned

Jun 17, 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 identifiers 1

Other names 1

• Ennoble Skilled Nursing and Rehabilitation 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": "1276732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276732800000",
    "number": "1982925509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 PASADENA DR",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "520010808",
            "telephone_number": "563-577-1076",
            "fax_number": "563-584-0671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 PASADENA DR",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "520010808",
            "telephone_number": "563-577-1076",
            "fax_number": "563-584-0671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT CARE ENNOBLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-17",
        "last_updated": "2010-06-17",
        "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": "IA",
            "license": "310764",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0801183",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ennoble Skilled Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Richard Corfman, LISW
• Cornerstone Caregiving East LLC
• Cornish Chiropractic LLC
• Carolyn Cornish, DC
• County of Dubuque
• Brian Welford Covey, M.D.
• Caitlyn Sue Cox
• Kathryn Coyle
• Bradley Richard Coyne
• Cozy Corner Adult Day Care

• Skilled Nursing Facility in Dubuque, IA
• Providers in Dubuque, IA by specialty
• Skilled Nursing Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 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.