Provider Demographics
NPI:1366781866
Name:SOVEREIGN JOURNEY L3C
Entity type:Organization
Organization Name:SOVEREIGN JOURNEY L3C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FITZHUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:603-869-7318
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:NH
Mailing Address - Zip Code:03574-0216
Mailing Address - Country:US
Mailing Address - Phone:603-869-7318
Mailing Address - Fax:
Practice Address - Street 1:2444 MAIN ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:NH
Practice Address - Zip Code:03574-4916
Practice Address - Country:US
Practice Address - Phone:603-869-7318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03806323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility