NPIMap

Organization Active NPI

Zebulon Rehabilitation Center, LLC

Doing business as Zebulon Rehabilitation Center

  • Skilled Nursing Facility
  • Zebulon, NC
National Provider Identifier
1164848503
Registry record updated Sep 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH0317 Issued in NC
Legal business name
ZEBULON REHABILITATION CENTER, LLC
Doing business as
Zebulon Rehabilitation Center
Practice address
509 W Gannon Ave
Zebulon, NC 27597-2509
Phone
(919) 269-9621
Fax
(919) 269-5703
NPI assigned
Mar 10, 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 NH0317 NC Primary

Addresses

Primary practice location

509 W Gannon Ave
Zebulon, NC 27597-2509

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1164848503MedicaidNC

Other names 1

  • Zebulon 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
O20140425001748 NC Part A Provider - Skilled Nursing Facility 4587897640 Practice locations: Zebulon, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164848503. Details of each certification follow.

Skilled nursing facility certification: CCN 345104

Legal name
ZEBULON REHABILITATION CENTER LLC
Doing business as
ZEBULON REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 15, 1973
Last certification
Jun 27, 2024
Beds
60
Ownership / control type
Corporation
Multi-facility organization
Southern Healthcare Management
Organization structure
LLCProprietary
Enrollment address
509 W Gannon Ave
Zebulon, NC 27597-2509
Nursing home name
ZEBULON REHABILITATION CENTER
Affiliated entity
SOVEREIGN HEALTHCARE HOLDINGS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Zebulon Rehabilitation CenterCCN 345104 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Sep 15, 1973
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6057.4 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
34D0667970Zebulon Rehabilitation Center, LLC509 W Gannon Avenue, Zebulon, NC 27597Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Robert Peck Individual Managing Control - Governing BodyVice President of Operations Jun 29, 2026
Adp of the SNF Jun 29, 2026
Susan Kaar Individual Managing Control - Governing BodyVP of Compliance and Quality MGMT May 1, 2014
Adp of the SNF May 1, 2014
Sovereign Carolina Disbursements, LLC Organization, Casselberry, FL LLC Adp of the SNF May 1, 2014
John Mangine Individual Operational/Managerial Control May 1, 2014
Adp of the SNF May 1, 2014
Indirect Ownership Interest May 1, 2014 4.9%
HSP Carolina, LLC Organization, Casselberry, FL LLC Adp of the SNF Jul 2, 2025
Southern Healthcare Management LLC Organization, Casselberry, FL LLC, Management services company, For-profit Operational/Managerial Control May 1, 2014 100%
Adp of the SNF Jul 2, 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
William Notermann Individual Adp of the SNF Jun 15, 2023
Gabriella Skillen Individual Operational/Managerial Control Jun 8, 2023
Adp of the SNF Jun 8, 2023
Waseem Ghannam Individual Operational/Managerial Control May 1, 2026
Adp of the SNF May 1, 2026
Royce M Cronquist Individual Operational/Managerial Control Feb 1, 2018
Adp of the SNF Feb 1, 2018
John J Notermann Business TR Organization, Atlanta, GA Indirect Ownership Interest Nov 12, 2017 80.9%
Forvis Mazars LLP Organization, Springfield, MO Adp of the SNF Jan 1, 2025
Dawn Chery Individual Managing Control - Governing BodyChief Nursing Officer Jun 8, 2017
Adp of the SNF Jun 8, 2017
Sovereign Carolina Holdings LLC Organization, Atlanta, GA LLC, Holding company, For-profit, Owned by another organization or individual Direct Ownership Interest Mar 6, 2014 100%
Cronquist 2015 Family TR Organization, Atlanta, GA Indirect Ownership Interest Dec 31, 2015 14.2%

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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1394409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411948800000",
    "number": "1164848503",
    "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": "509 W GANNON AVE",
            "city": "ZEBULON",
            "state": "NC",
            "postal_code": "275972509",
            "telephone_number": "919-269-9621",
            "fax_number": "919-269-5703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ZEBULON REHABILITATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-10",
        "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": "NH0317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1164848503",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Zebulon Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Zebulon, NC

Sources for this page

Verify at the official NPI Registry.