Provider Demographics
NPI:1548942279
Name:CARING COVENANT COMMUNITY HOME, LLC
Entity type:Organization
Organization Name:CARING COVENANT COMMUNITY HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTOINE
Authorized Official - Middle Name:MOURY'E
Authorized Official - Last Name:BEACHUM
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:817-528-0971
Mailing Address - Street 1:PO BOX 1114
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-8114
Mailing Address - Country:US
Mailing Address - Phone:817-528-0971
Mailing Address - Fax:469-779-6112
Practice Address - Street 1:610 UPTOWN BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3528
Practice Address - Country:US
Practice Address - Phone:817-528-0971
Practice Address - Fax:469-779-6112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities