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General NPI Number Information
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NPI Number | 1306268933
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Entity Type | Organization
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Legal Business Name | SOVEREIGN CASE MANAGEMENT LLC
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Dates
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Enumeration Date | 01/16/2014
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Last Update Date | 01/16/2014
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Provider Practice Location Address
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Address Line | 10121 LOCKSLEY DR
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City | BENBROOK
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State | TX
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Zip | 76126-4010
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Country | US
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Telephone | 817-760-0407
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Fax |
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Provider Business Mailing Address
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Address Line | 10121 LOCKSLEY DR
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City | BENBROOK
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State | TX
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Zip | 76126-4010
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Country | US
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Telephone | 817-760-0407
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. SHERRY PACLEB
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Credential | RN, CCM
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Telephone | 817-760-0407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 590813
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License Number State | TX
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