COVENTRY HOMESTEAD, LLC (NPI# 1558527390) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558527390 |
| Entity Type | Organization |
| Organization Name | COVENTRY HOMESTEAD, LLC |
| Practice Address |
19402 Coventry St Detroit MI 48203-4909 |
| Practice Telephone | 3133684649 |
| Practice Fax Number | 3133684649 |
| Mailing Telephone | 3133684649 |
| Mailing Fax Number | 3133684649 |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2008-07-31 |
| Authorized Official Name | MR. ANTHONY WAYNE BONEY (PRESIDENT) |
| Authorized Official Telephone | 3133684649 |
| Authorized Official Credential | MECHANICAL ENGIN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
AS820289860 | MI | Nursing & Custodial Care Facilities |
| Street Address |
19402 COVENTRY ST |
| City | DETROIT |
| State | MI |
| Zip Code | 48203-4909 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992355135 | James Calloway | Peer Specialist | 1211 E Mcnichols, Detroit, MI 48203 | 2019-09-19 |
| 1851868582 | Community Veterans Services Inc | Counselor | 163 Tennyson, Highland Park, MI 48203 | 2018-10-31 |
| 1346601838 | Rainbow Center of Michigan | Health Maintenance Organization | 12501 Hamilton Ave., Highland Park, MI 48203 | 2016-03-11 |
| 1134502354 | Minds Moving In New Directions Inc | Community/Behavioral Health | 62 Massachusetts St, Highland Park, MI 48203 | 2015-07-07 |
| 1811312937 | Brea Holloway | Home Health | 20249 Yacama Rd, Detroit, MI 48203 | 2014-02-26 |
| 1770821795 | St John Providence Health Systems | Community/Behavioral Health | 1150 Lantz St, Detroit, MI 48203 | 2013-01-25 |
| 1871845412 | Waneta Darcell Dickerson | Social Worker | 169 W. Buena Vista, Highlandpark, MI 48203 | 2012-10-05 |
| 1629331939 | Maureen Connolly | Pediatrics | 77 Victor St, Highland Park, MI 48203 | 2012-06-21 |
| 1578850251 | Detroit Recovery Project | Community/Behavioral Health | 1121 East Mc Nichols, Detroit, MI 48203 | 2011-07-01 |
| 1265728414 | Barbara Suzanne Tyson | Home Health | 301 Glendale St, Apt B8, Highland Park, MI 48203 | 2011-06-27 |
| Find all providers in zip 48203 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063028694 | Zcare | Custodial Care Facility | 8676 Auburn St, Detroit, MI 48228-2919 | 2020-09-18 |
| 1790397594 | St. Ruth's House of Hope LLC | Custodial Care Facility | 3100 S Electric St, Detroit, MI 48217-1133 | 2020-08-21 |
| 1558837229 | New Center Inn Company | Custodial Care Facility | 158 Pingree St, Detroit, MI 48202-2022 | 2018-10-19 |
| 1477029700 | Acon Services, Inc. | Custodial Care Facility | 17126 Prevost St, Detroit, MI 48235-3551 | 2018-10-14 |
| 1619452588 | Hudson Home 1 Inc | Custodial Care Facility | 750 Virginia Park St, Detroit, MI 48202-2033 | 2018-09-26 |
| 1578083077 | New Advantage Inc. | Custodial Care Facility | 15375 Ardmore St, Detroit, MI 48227-3222 | 2017-06-26 |
| 1003348145 | Reality Response LLC | Custodial Care Facility | 2455 W Grand St, Detroit, MI 48238-3445 | 2017-03-29 |
| 1376080614 | Crystal Serenity House | Custodial Care Facility | 14241 Faust Ave Ste 200-b, Detroit, MI 48223-3574 | 2017-01-25 |
| 1225585250 | Maan Down LLC | Custodial Care Facility | 16885 Ilene St, Detroit, MI 48221 | 2016-09-07 |
| 1881051712 | Tasha Harris | Custodial Care Facility | 6402 Penrod St, Detroit, MI 48228-4748 | 2016-01-22 |
| Find all providers in DETROIT | ||||
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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.