| Covenant Community Care, Inc. | |
|
1700 Waterman St Detroit MI 48209-2022 | |
| (313) 841-1612 | |
| (313) 554-1918 |
| Full Name | Covenant Community Care, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1700 Waterman St, Detroit, Michigan |
| Authorized Official Name and Position | Anna Griebel Chavez (CFO) |
| Authorized Official Contact | 3135540485 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Covenant Community Care, Inc. 559 W Grand Blvd Detroit MI 48216-2200 Ph: (313) 554-0485 | Covenant Community Care, Inc. 1700 Waterman St Detroit MI 48209-2022 Ph: (313) 841-1612 |
| NPI Number | 1255574265 |
|---|---|
| Provider Enumeration Date | 04/07/2009 |
| Last Update Date | 04/10/2023 |
| Medicare PECOS PAC ID | 1254393549 |
|---|---|
| Medicare Enrollment ID | O20080326000806 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255574265 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 4704195855 (Michigan) | Primary |
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