Provider Demographics
NPI:1851957294
Name:SOVEREIGN CARE SERVICES
Entity Type:Organization
Organization Name:SOVEREIGN CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-450-3504
Mailing Address - Street 1:2500 BRUNSWICK PIKE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-4134
Mailing Address - Country:US
Mailing Address - Phone:609-450-3504
Mailing Address - Fax:
Practice Address - Street 1:1346 HOW LN # 104
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1725
Practice Address - Country:US
Practice Address - Phone:609-450-3504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOVEREIGN CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0560120Medicaid