Provider Demographics
NPI:1710248083
Name:SOVEREIGN HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:SOVEREIGN HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:
Authorized Official - Last Name:EFFA
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:860-461-1361
Mailing Address - Street 1:135 BURNSIDE AVE
Mailing Address - Street 2:2A
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3466
Mailing Address - Country:US
Mailing Address - Phone:860-461-1631
Mailing Address - Fax:860-206-3815
Practice Address - Street 1:135 BURNSIDE AVE STE A2
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3421
Practice Address - Country:US
Practice Address - Phone:860-461-1631
Practice Address - Fax:860-206-3815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0000578305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization