MEDICARE: SOVEREIGN HEALTHCARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility		IL

General Provider Information

NPI Number	:	1174529614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOVEREIGN HEALTHCARE

Provider Business Mailing Address
First Line	:	6500 N HAMLIN
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712
Country	:	US
Telephone Number	:	847-679-7484
Fax Number	:	847-679-7494

Provider Business Practice Location Address
First Line	:	6159 N KENMORE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-2722
Country	:	US
Telephone Number	:	773-761-9050
Fax Number	:	773-761-9055

Authorized Official
Title or Position	:	BOOKKEEPER
Name	:	MR. DAVID LUBOWSKY
Credential	:
Telephone Number	:	847-679-7484

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	08/22/2020

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Directions to “SOVEREIGN HEALTHCARE ” Practice Location

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