Provider Demographics
NPI:1386883700
Name:COVENANT CHILD INC
Entity type:Organization
Organization Name:COVENANT CHILD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUPE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:575-746-6277
Mailing Address - Street 1:801 W BUSH AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-1255
Mailing Address - Country:US
Mailing Address - Phone:575-746-6277
Mailing Address - Fax:575-746-6471
Practice Address - Street 1:801 W BUSH AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-1255
Practice Address - Country:US
Practice Address - Phone:575-746-6277
Practice Address - Fax:575-746-6471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM020080358OtherCITY OF ARTESIA BUSINESS LICENSE