Provider Demographics
NPI:1154551976
Name:COVENANT HEALTHCARE SERVICES & STAFFING INC.
Entity type:Organization
Organization Name:COVENANT HEALTHCARE SERVICES & STAFFING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:MR
Authorized Official - First Name:TAIWO
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADENIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:773-416-1983
Mailing Address - Street 1:840 E 87TH ST
Mailing Address - Street 2:SUITE 211A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-6248
Mailing Address - Country:US
Mailing Address - Phone:773-487-9550
Mailing Address - Fax:773-487-9551
Practice Address - Street 1:840 E 87TH ST
Practice Address - Street 2:SUITE 211A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6248
Practice Address - Country:US
Practice Address - Phone:773-487-9550
Practice Address - Fax:773-487-9551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011105251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1011105OtherMEDICARE LICENCE #