COVENANT COMMUNITY CARE INC. NPI 1073834818

NPI Information

NPI: 1073834818
Provider Name: COVENANT COMMUNITY CARE, INC.

Other Name: COVENANT WOODWARD AVENUE

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
27776 WOODWARD AVE
ROYAL OAK, MI
ZIP 48067
Phone: (248) 556-4900
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COVENANT COMMUNITY CARE, INC. is a federally qualified health center (fqhc) clinic center in Royal Oak, MI. COVENANT COMMUNITY CARE, INC. NPI is 1073834818. The provider is registered as an organization entity type.
The provider Other Name Is Covenant Woodward Avenue.

The provider's business location address is:

27776 WOODWARD AVE
ROYAL OAK, MI
ZIP 48067-930
Phone: (248) 556-4900
Fax: (248) 556-4950

The provider's authorized official is Joslyn Pettway .
The authorized official title is Chief Executive Officer and has the following contact phone number (313) 554-0485.

The CLIA number assigned to this NPI record is 23D1071126 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/16/2010 and was last updated on 5/18/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	4704195855	MICHIGAN	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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