Provider Demographics
NPI:1164129706
Name:SOVEREIGN ROCKY RIVER LLC
Entity Type:Organization
Organization Name:SOVEREIGN ROCKY RIVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:CALABRASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-302-2719
Mailing Address - Street 1:14801 HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-3092
Mailing Address - Country:US
Mailing Address - Phone:216-302-2719
Mailing Address - Fax:
Practice Address - Street 1:27420 MILL RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3190
Practice Address - Country:US
Practice Address - Phone:216-302-2719
Practice Address - Fax:216-302-2721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility