Organization
SOVEREIGN HEALTHCARE OF PORT ST. LUCIE, LLC
Active
Other names
Tiffany Hall 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
1800 SE HILLMOOR DR, PORT ST LUCIE, FL 34952-7542
(772) 337-3565
(772) 337-2989
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
SNF15590961
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026353200
—
FL
01
—
V548P-1065
VA
—
Enumeration date
09/29/2005
Last updated
09/24/2014
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us