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General NPI Number Information
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NPI Number | 1750691283
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Entity Type | Organization
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Legal Business Name | SOVEREIGNTY COMMUNITY CARE
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 7288 HANOVER GREEN DR
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-1706
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Country | US
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Telephone | 919-264-7517
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Fax |
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Provider Business Mailing Address
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Address Line | 604 CALAVARAS LN
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City | KNIGHTDALE
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State | NC
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Zip | 27545-7350
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Country | US
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Telephone | 919-261-9083
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Fax |
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Authorized Official
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Title or Position | OWNER/ DIRECTOR
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Name | GARRICK JONES
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Credential |
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Telephone | 919-261-9083
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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 |
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License Number State |
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