Provider Demographics
NPI:1033498613
Name:SOVEREIGN BUSINESS MANAGEMENT, INC.
Entity Type:Organization
Organization Name:SOVEREIGN BUSINESS MANAGEMENT, INC.
Other - Org Name:POSITIVE IMPRINTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:305-308-9932
Mailing Address - Street 1:5010 SW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3271
Mailing Address - Country:US
Mailing Address - Phone:305-308-9932
Mailing Address - Fax:
Practice Address - Street 1:2331 N STATE ROAD 7
Practice Address - Street 2:SUITE 124
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-3748
Practice Address - Country:US
Practice Address - Phone:305-308-9932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1005984251300000X
FLMT 2758251S00000X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No251300000XAgenciesLocal Education Agency (LEA)
No251S00000XAgenciesCommunity/Behavioral Health