03D2164425 CLIA NUMBER - COVENANT HOME HEALTH

Laboratory Demographics

CLIA Number: 03D2164425

Facility Name: COVENANT HOME HEALTH

Facility Address:
11830 N 19TH AVE, STE 102
PHOENIX, AZ
ZIP 85029
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Facility Phone Number: 602 443-5482

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1093025439

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name	Field Value
CLIA Number	03D2164425
LAB Type	Home Health Agency
Facility Name	COVENANT HOME HEALTH
Street	11830 N 19TH AVE, STE 102
City	PHOENIX
State	AZ
ZIP	85029
Phone	602 443-5482
CertificateType	4
CertificateEffectiveDate	4/4/2023
CertificateExpirationDate	4/3/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024