Provider Demographics
NPI:1760853683
Name:SOVEREIGN HEALTH OF MASSACHUSETTS, INC
Entity Type:Organization
Organization Name:SOVEREIGN HEALTH OF MASSACHUSETTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONMOY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-369-1300
Mailing Address - Street 1:1211 PUERTA DEL SOL STE 200
Mailing Address - Street 2:SUITE 280
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6342
Mailing Address - Country:US
Mailing Address - Phone:949-297-5553
Mailing Address - Fax:
Practice Address - Street 1:14 CHESTNUT PL
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-3476
Practice Address - Country:US
Practice Address - Phone:949-276-5553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility