Organization
SOVEREIGN HEALTHCARE OF TITUSVILLE, LLC
Active
Other names
Royal Oaks Nursing & Rehab Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. R. MARK CRONQUIST (MANAGER)
(404) 574-2100
Entity
Organization
Contact information
Practice address
2225 KNOX MCRAE DR, TITUSVILLE, FL 32780-5236
(321) 267-0060
(321) 268-3303
Mailing address
5887 GLENRIDGE DR, SUITE 150, ATLANTA, GA 30328-5574
(404) 574-2100
(404) 574-2105
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF14650962
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026358300
—
FL
01
—
V673P-5335
VA
—
Enumeration date
09/29/2005
Last updated
09/24/2014
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