Organization
SOVEREIGN HEALTHCARE OF TUSKAWILLA, LLC
Active
Other names
Tuskawilla 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
1024 WILLA SPRINGS DR, WINTER SPRINGS, FL 32708-5214
(407) 699-5506
(407) 699-8269
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
SNF1625096
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026359100
—
FL
01
—
V573P-6390
VA
—
Enumeration date
09/29/2005
Last updated
09/24/2014
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