Healthcare Provider Details

I. General information

NPI: 1215842950
Provider Name (Legal Business Name): SOVEREIGN HEALTHCARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N MAIN ST
SIKESTON MO
63801-5013
US

IV. Provider business mailing address

PO BOX 152
NEW MADRID MO
63869-0152
US

V. Phone/Fax

Practice location:
  • Phone: 573-481-4206
  • Fax: 573-748-6070
Mailing address:
  • Phone: 573-481-4206
  • Fax: 619-775-8453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: VASHENE BARFIELD
Title or Position: PRESIDENT
Credential:
Phone: 619-775-8453