Provider Demographics
NPI:1144609090
Name:SOVEREIGN HOME HEALTH OF CONNECTICUT LLC
Entity Type:Organization
Organization Name:SOVEREIGN HOME HEALTH OF CONNECTICUT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAIN
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:203-858-4021
Mailing Address - Street 1:15 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-1365
Mailing Address - Country:US
Mailing Address - Phone:203-858-4021
Mailing Address - Fax:203-846-4400
Practice Address - Street 1:15 OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-1365
Practice Address - Country:US
Practice Address - Phone:203-858-4021
Practice Address - Fax:203-846-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA.0000886253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care