Healthcare Provider Details

I. General information

NPI: 1033498613
Provider Name (Legal Business Name): SOVEREIGN BUSINESS MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 N STATE ROAD 7 SUITE 124
LAUDERDALE LAKES FL
33313-3748
US

IV. Provider business mailing address

5010 SW 19TH ST
WEST PARK FL
33023-3271
US

V. Phone/Fax

Practice location:
  • Phone: 305-308-9932
  • Fax:
Mailing address:
  • Phone: 305-308-9932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number1005984
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMT 2758
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberMT 2758
License Number StateFL

VIII. Authorized Official

Name: WALTER HOWARD
Title or Position: PRESIDENT
Credential: M.S.
Phone: 305-308-9932