COVENANT COMMUNITY CARE, INC. (NPI# 1255574265) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255574265 |
| Entity Type | Organization |
| Organization Name | COVENANT COMMUNITY CARE, INC. |
| Other Organization Name | WATERMAN |
| Practice Address |
1700 Waterman St Detroit MI 48209-2022 |
| Mailing Address |
559 W Grand Blvd Detroit MI 48216-2200 |
| Practice Telephone | 3138411612 |
| Practice Fax Number | 3135541918 |
| Mailing Telephone | 3135540485 |
| Mailing Fax Number | 3135543885 |
| Enumeration Date | 2009-04-07 |
| Last Update Date | 2009-04-07 |
| Authorized Official Name | MR. PAUL PROPSON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 3135540485 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
4704195855 | MI | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Waterman | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700377538 | Covenant Community Care, Inc. | Pharmacy | 5716 Michigan Ave, Detroit, MI 48210-3039 | 2018-05-29 |
| 1528557105 | Covenant Community Care, Inc. | Optometrist | 5716 Michigan Ave, Detroit, MI 48210-3039 | 2018-05-09 |
| 1689925075 | Covenant Community Care, Inc. | Clinic/Center | 20901 Moross Rd, Detroit, MI 48236-2058 | 2012-09-25 |
| 1073834818 | Covenant Community Care, Inc. | Clinic/Center | 27776 Woodward Ave, Royal Oak, MI 48067-0930 | 2010-06-16 |
| 1720134943 | Covenant Community Care, Inc. | Clinic/Center | 5716 Michigan Ave, Detroit, MI 48210-3039 | 2007-01-28 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | COVENANT COMMUNITY CARE, INC. | 559 W Grand Blvd, Detroit, MI 48216-2200 |
| Street Address |
1700 WATERMAN ST |
| City | DETROIT |
| State | MI |
| Zip Code | 48209-2022 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437169786 | Jaswant Purohit | Psychiatry & Neurology | 1700 Waterman St, Detroit, MI 48209-2022 | 2006-08-09 |
| 1912513839 | Erica Medina | Counselor | 1700 Waterman St, Detroit, MI 48209-2022 | 2020-09-16 |
| 1952934366 | Laura Owens | Registered Nurse | 1700 Waterman St, Detroit, MI 48209-2022 | 2020-02-14 |
| 1013556026 | Jamice Sade' Harris | Social Worker | 1700 Waterman St, Detroit, MI 48209-2022 | 2019-12-23 |
| 1033755269 | Rodney Harold Averett | Counselor | 1700 Waterman St, Detroit, MI 48209-2022 | 2019-11-22 |
| 1124685433 | Kristina Nicole Henning | Social Worker | 1700 Waterman St, Detroit, MI 48209-2022 | 2019-05-22 |
| 1861952517 | Edward Grumeretz | Social Worker | 1700 Waterman St, Detroit, MI 48209-2022 | 2019-03-20 |
| 1679047427 | Candice Taylor | Technician, Other | 1700 Waterman St, Detroit, MI 48209-2022 | 2019-01-15 |
| 1154826311 | Stephanye Lavenant | Case Manager/Care Coordinator | 1700 Waterman St, Detroit, MI 48209-2022 | 2018-03-28 |
| 1356846612 | Mary Regina Martinez | Case Manager/Care Coordinator | 1700 Waterman St, Detroit, MI 48209-2022 | 2018-03-28 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316501471 | El Valle Optical, Inc. | Eyewear Supplier (Equipment, not the service) | 1940 Campbell, Detroit, MI 48209 | 2019-04-24 |
| 1598211583 | Elizabeth Lopez-riachi | Technician, Other | 1551 Cavaqlry St., Detroit, MI 48209 | 2016-08-30 |
| 1205210333 | Yamirka Torres | Behavioral Analyst | 1551 Cavalry St, Detroit, MI 48209 | 2015-07-18 |
| 1689943359 | Jessica Male | Pharmacist | 6223 W Jefferson Ave, Detroit, MI 48209 | 2011-12-23 |
| 1003070723 | Mark Beard | General Practice | 5700 W Vernor Hwy, Detroit, MI 48209 | 2008-07-11 |
| 1891980330 | Emery K Toth | Dentist | 8028 W Vernor Hwy, Detroit, MI 48209 | 2007-09-07 |
| 1225131881 | Eva A Karmo | Dentist | 4607 W. Vernor Hwy, Detroit, MI 48209 | 2006-09-07 |
| 1023123858 | Wanda E Velez Ruiz | Internal Medicine | 4115 W Vernor, Detroit, MI 48209 | 2006-08-20 |
| 1235142563 | Wendy Yousif Mckay | Family Medicine | 5831 W Vernor, Detroit, MI 48209 | 2006-08-15 |
| 1316950645 | Sahir H Cittan | Family Medicine | 5831 West Vernor, Detroit, MI 48209 | 2006-08-15 |
| Find all providers in zip 48209 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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|---|---|---|---|---|
| 1679195721 | Family Medical Center of Michigan,inc | Clinic/Center | 2740 Collingwood St Ste 100, Detroit, MI 48206-1473 | 2020-05-12 |
| 1154892958 | Family Medical Center of Michigan, Inc | Clinic/Center | 2425 Tuxedo St Rm 115, Detroit, MI 48206-1222 | 2018-12-06 |
| 1801361464 | Detroit Health Care for The Homeless | Clinic/Center | 1355 Oakman Blvd, Detroit, MI 48238-2849 | 2018-10-10 |
| 1306329800 | Family Medical Center of Michigan,inc | Clinic/Center | 15531 Linwood St Rm 102, Detroit, MI 48238-1465 | 2018-09-11 |
| 1982072963 | Detroit Healthcare for The Homeless | Clinic/Center | 1234 Porter St, Detroit, MI 48226-2407 | 2015-09-09 |
| 1851554034 | Detroit Community Health Connection, Inc | Clinic/Center | 111 W 7 Mile Rd, Detroit, MI 48203-1968 | 2008-07-08 |
| 1396839981 | Detroit Health Care for The Homeless | Clinic/Center | 60 E. Warren, Detroit, MI 48201 | 2006-10-03 |
| 1285735845 | Detroit Health Care for The Homeless | Clinic/Center | 20548 Fenkell, Detroit, MI 48223 | 2006-09-26 |
| 1275576886 | Ronaldo B Supena | Clinic/Center | 611 Martin Luther King Jr Blvd, Detroit, MI 48201-2273 | 2006-06-13 |
| 1033109244 | Community Health and Social Services Center, Inc | Clinic/Center | 7436 Woodward Ave, Detroit, MI 48202-3100 | 2005-10-27 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.