Provider Demographics
NPI:1588107825
Name:COVERED BY FAITH
Entity type:Organization
Organization Name:COVERED BY FAITH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTWON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARALSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-566-3511
Mailing Address - Street 1:PO BOX 503
Mailing Address - Street 2:
Mailing Address - City:KEEGO HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48320-0503
Mailing Address - Country:US
Mailing Address - Phone:313-566-3511
Mailing Address - Fax:248-856-2799
Practice Address - Street 1:3240 PRIBHAM
Practice Address - Street 2:
Practice Address - City:KEEGO HARBOR
Practice Address - State:MI
Practice Address - Zip Code:48320-0503
Practice Address - Country:US
Practice Address - Phone:313-566-3511
Practice Address - Fax:248-856-2799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care