Provider Demographics
NPI:1306101886
Name:COVENANT HUMAN SERVICES
Entity type:Organization
Organization Name:COVENANT HUMAN SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MHP
Authorized Official - Prefix:MR
Authorized Official - First Name:ODUWA
Authorized Official - Middle Name:A
Authorized Official - Last Name:AGANMWONYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-528-8303
Mailing Address - Street 1:4080 W BROADWAY AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-5604
Mailing Address - Country:US
Mailing Address - Phone:763-528-8303
Mailing Address - Fax:763-537-8892
Practice Address - Street 1:4080 W. BROADWAY AVE
Practice Address - Street 2:SUITE #125
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55429
Practice Address - Country:US
Practice Address - Phone:763-528-8303
Practice Address - Fax:763-537-8891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care