Organization
SOVEREIGN HEALTHCARE OF ATLANTIC SHORES, LLC
Active
Other names
Atlantic Shores Nursing And 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
4251 STACK BLVD, MELBOURNE, FL 32901-8526
(321) 953-2219
(321) 953-2002
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
SNF16420951
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026338900
—
FL
01
—
V673P-5340
VA
—
Enumeration date
09/29/2005
Last updated
09/24/2014
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