MEDICARE: SOVEREIGN HOME HEALTH SERVICES, INC.

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	251E00000X	Home Health Agency	004111	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548222581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOVEREIGN HOME HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	8610 GREENVILLE AVE
Second Line	:	SUITE 100
City	:	DALLAS
State	:	TX
Zip	:	75243-7144
Country	:	US
Telephone Number	:	214-503-7700
Fax Number	:	214-503-1221

Provider Business Practice Location Address
First Line	:	8610 GREENVILLE AVE
Second Line	:	SUITE 100
City	:	DALLAS
State	:	TX
Zip	:	75243-7144
Country	:	US
Telephone Number	:	214-503-7700
Fax Number	:	214-503-1221

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RANDY MARCEL DUVALLE
Credential	:	PT
Telephone Number	:	214-503-7700

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	08/22/2020

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