Provider Demographics
NPI:1215093737
Name:COVENANT WOODS
Entity type:Organization
Organization Name:COVENANT WOODS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURITSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-569-8173
Mailing Address - Street 1:7090 COVENANT WOODS DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-7025
Mailing Address - Country:US
Mailing Address - Phone:804-569-8000
Mailing Address - Fax:804-569-8177
Practice Address - Street 1:7090 COVENANT WOODS DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-7025
Practice Address - Country:US
Practice Address - Phone:804-569-8000
Practice Address - Fax:804-569-8177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VANH2662OtherNURSING HOME LICENSE NUMBER