Provider Demographics
NPI:1447821418
Name:SOVEREIGN HEALTHCARE GROUP, LLC
Entity type:Organization
Organization Name:SOVEREIGN HEALTHCARE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:BEDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-1276
Mailing Address - Street 1:P.O. BOX 1210
Mailing Address - Street 2:731 N MAIN STREET
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-1210
Mailing Address - Country:US
Mailing Address - Phone:573-471-1276
Mailing Address - Fax:573-472-8504
Practice Address - Street 1:35 VILLA SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:NEW MADRID
Practice Address - State:MO
Practice Address - Zip Code:63869
Practice Address - Country:US
Practice Address - Phone:573-621-3126
Practice Address - Fax:573-748-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health