Organization Name: | COVENANT MEDICAL SUPPLY, INC. |
NPI Number: | 1205905718 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LLOYD UDONWA NSEK (CHIEF EXECUTIVE OFFICER) |
Mailing Address: | 351 Wilkerson Ave Suite A Perris |
State: | CA US |
Postal Code: | 925702203 |
Phone Number: | 9519433900 |
Fax Number: | 9519433939 |
NPI Enumeration Date: | 11/07/2006 |
NPI Last Update Date: | 05/14/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332BC3200X |
License Number: | 47574 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | Customized Equipment |
Taxonomy Definition: |