Provider Demographics
NPI:1699523977
Name:COVENANT BEHAVIORAL HEALTH RESIDENTIAL FACILITY.
Entity type:Organization
Organization Name:COVENANT BEHAVIORAL HEALTH RESIDENTIAL FACILITY.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADANE
Authorized Official - Middle Name:HAILE
Authorized Official - Last Name:NIGANI
Authorized Official - Suffix:
Authorized Official - Credentials:BHPP
Authorized Official - Phone:623-330-7509
Mailing Address - Street 1:5322 W SHUMWAY FARM RD
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-6925
Mailing Address - Country:US
Mailing Address - Phone:623-330-7509
Mailing Address - Fax:
Practice Address - Street 1:5322 W SHUMWAY FARM RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-6925
Practice Address - Country:US
Practice Address - Phone:623-330-7509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances