Provider Demographics
NPI:1174529614
Name:SOVEREIGN HEALTHCARE
Entity type:Organization
Organization Name:SOVEREIGN HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-679-7484
Mailing Address - Street 1:6500 N HAMLIN
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712
Mailing Address - Country:US
Mailing Address - Phone:847-679-7484
Mailing Address - Fax:847-679-7494
Practice Address - Street 1:6159 N KENMORE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-2722
Practice Address - Country:US
Practice Address - Phone:773-761-9050
Practice Address - Fax:773-761-9055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========801Medicaid
IL=========001Medicaid
IL=========001Medicaid