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General NPI Number Information
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NPI Number | 1932717618
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Entity Type | Organization
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Legal Business Name | SOVEREIGN AND GRACE SERVICES
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Dates
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Enumeration Date | 07/17/2020
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 551 SMITH AVE STE A
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City | THOMASVILLE
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State | GA
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Zip | 31792-5657
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Country | US
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Telephone | 229-236-2585
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Fax |
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Provider Business Mailing Address
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Address Line | 241 POINT RD
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City | THOMASVILLE
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State | GA
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Zip | 31757-0940
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Country | US
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Telephone | 229-403-5252
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Fax | 229-226-6170
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Authorized Official
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Title or Position | CEO/FINANCIAL MANAGER
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Name | MR. KULUVANDA QUARLETTE CASON
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Credential | LPN
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Telephone | 229-236-2585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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