Provider Demographics
NPI:1083916381
Name:COVENANT COMMUNITY PARTNERS LLC
Entity type:Organization
Organization Name:COVENANT COMMUNITY PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:MUNROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-401-8000
Mailing Address - Street 1:1803 CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-1175
Mailing Address - Country:US
Mailing Address - Phone:919-401-8000
Mailing Address - Fax:919-401-8006
Practice Address - Street 1:1803 CHAPEL HILL RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-1175
Practice Address - Country:US
Practice Address - Phone:919-401-8000
Practice Address - Fax:919-401-8006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC253J00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3410062Medicaid
NC8703059Medicaid