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Organization
SOVEREIGN HOUSE OF RESPITE, LLC
Active
Organization
SOVEREIGN HOUSE OF RESPITE, LLC
Active
Other names
Sovereign House Agency, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VICKY / GLORIA JOLLY / LEWIS (OWNERS/ADMINISTRATORS)
(706) 304-4325
Entity
Organization
Contact information
Practice address
5977 WHITESVILLE RD, UNIT 14, COLUMBUS, GA 31904-3660
(706) 221-6281
(706) 221-6289
Mailing address
5977 WHITESVILLE RD, UNIT 14, COLUMBUS, GA 31904-3660
(706) 221-6281
(706) 221-6289
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
—
GA
Other
Enumeration date
09/27/2010
Last updated
11/29/2012
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