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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