Healthcare Provider Details

I. General information

NPI: 1104751890
Provider Name (Legal Business Name): THE SOVEREIGN SISTER MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 RICHARDS AVE NW
GRAND RAPIDS MI
49504-5452
US

IV. Provider business mailing address

35 RICHARDS AVE NW
GRAND RAPIDS MI
49504-5452
US

V. Phone/Fax

Practice location:
  • Phone: 313-777-9097
  • Fax:
Mailing address:
  • Phone: 616-408-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: VALERIE DOCK
Title or Position: OWNER
Credential:
Phone: 616-408-6161