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Contact Information

COVENANT CARE OF JACKSONVILLE LLC
1500 WEST WALNUT STREET
JACKSONVILLE, IL62650-1134
 Phone: 217-245-4183
 Fax: 217-243-2915
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nursing Facility/Intermediate Care Facility

313M00000X A3[10] Other Nursing Facility
 

Skilled Nursing Facility

314000000X A1[8] Skilled Nursing Facility
Indicates primary specialty

NPI Profile & details for COVENANT CARE OF JACKSONVILLE LLC

NPI # 1396811550
LBN Legal business name COVENANT CARE OF JACKSONVILLE LLC
Authorized official GARY POTTS - (MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 11/28/2006
Last updated 07/19/2007 - About 19 years ago
Identifiers
IL License # 0047852
IL License # 1764855
IL Medicaid 0036301
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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