NPIMap

Organization Active NPI

Pettigrew Rehabilitation Center, LLC

  • Skilled Nursing Facility
  • Durham, NC
National Provider Identifier
1144646274
Registry record updated Sep 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH0119 Issued in NC
Legal business name
PETTIGREW REHABILITATION CENTER, LLC
Practice address
1515 W Pettigrew St
Durham, NC 27705-4821
Phone
(919) 286-0751
Fax
(919) 286-7065
NPI assigned
Mar 13, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. R. Mark Cronquist
Title
Manager
Phone
(404) 574-2100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X
Skilled Nursing Facility 314000000X NH0119 NC Primary

Addresses

Primary practice location

1515 W Pettigrew St
Durham, NC 27705-4821

Mailing address

5887 Glenridge Dr
Suite 150
Atlanta, GA 30328-5574
Phone (404) 574-2100

Other identifiers 1

IdentifierTypeStateIssuer
1144646274MedicaidNC

Other names 1

  • Pettigrew Rehabilitation Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140423001236 NC Part A Provider - Skilled Nursing Facility 9638302839 Practice locations: Durham, NC

Skilled nursing facility certification: CCN 345053

Legal name
PETTIGREW REHABILITATION CENTER LLC
Doing business as
PETTIGREW REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 19, 1969
Last certification
Mar 7, 2025
Beds
96
Ownership / control type
Limited Liability Corporation
Most recent change of ownership
May 1, 2014
Organization structure
LLCProprietary
Enrollment address
1515 W Pettigrew St
Durham, NC 27705-4821
Nursing home name
PETTIGREW REHABILITATION CENTER
Affiliated entity
SOVEREIGN HEALTHCARE HOLDINGS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Pettigrew Rehabilitation CenterCCN 345053
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 19, 1969
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9681.8 residents per day on average
Chain
Sovereign Healthcare Holdings43 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0241284Pettigrew Rehabilitation Center, LLC1515 West Pettigrew Street, Durham, NC 27705Certificate of waiverAug 28, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 20

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Patrick J O Brien Individual Operational/Managerial Control Jan 25, 2016
Adp of the SNF Jan 25, 2016
Organization, Casselberry, FL LLC Adp of the SNF Apr 11, 2025
Organization, Springfield, MO Adp of the SNF Apr 11, 2025
John Mangine Individual Operational/Managerial Control May 1, 2014
Adp of the SNF May 1, 2014
Indirect Ownership Interest May 1, 2014 4.9%
Southern Healthcare Management LLC Organization, Casselberry, FL LLC, Management services company Operational/Managerial Control May 14, 2014 100%
Adp of the SNF Apr 11, 2025
Michelle Kelly Individual Adp of the SNF Feb 1, 2018
Donald K Melton Individual Operational/Managerial Control May 1, 2014
Adp of the SNF May 1, 2014
Organization, Casselberry, FL LLC Adp of the SNF Apr 11, 2025
Organization, Tustin, CA Corporation Adp of the SNF May 1, 2014
Individual Adp of the SNF Jun 8, 2017
Rachael Burke Individual Operational/Managerial Control May 20, 2025
Adp of the SNF May 20, 2025
Organization, Tustin, CA LLC Adp of the SNF May 1, 2024
Royce M Cronquist Individual Operational/Managerial Control May 1, 2014
Adp of the SNF Feb 1, 2018
Individual Adp of the SNF May 1, 2014
Organization, Tustin, CA Adp of the SNF May 1, 2014
Individual Adp of the SNF Sep 1, 2021
John J Notermann Business TR Organization, Atlanta, GA Indirect Ownership Interest Nov 12, 2017 80.9%
Sovereign Carolina Holdings LLC Organization, Casselberry, FL LLC, Holding company, For-profit, Owned by another organization or individual Direct Ownership Interest Mar 6, 2014 100%
Cronquist 2015 Family TR Organization, Casselberry, FL Indirect Ownership Interest Dec 31, 2015 14.2%
Individual Adp of the SNF Jun 15, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 41

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 41

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1394668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411948800000",
    "number": "1144646274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5887 GLENRIDGE DR",
            "address_2": "SUITE 150",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303285574",
            "telephone_number": "404-574-2100",
            "fax_number": "404-574-2105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 W PETTIGREW ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277054821",
            "telephone_number": "919-286-0751",
            "fax_number": "919-286-7065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETTIGREW REHABILITATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-13",
        "last_updated": "2014-09-29",
        "status": "A",
        "authorized_official_last_name": "CRONQUIST",
        "authorized_official_first_name": "R.",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "404-574-2100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "NH0119",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1144646274",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pettigrew Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Durham, NC

Sources for this page

Verify at the official NPI Registry.