NPIMap

Organization Active NPI

Blountstown Rehabilitation Center, LLC

Doing business as River Valley Rehabilitation Center

  • Skilled Nursing Facility
  • Blountstown, FL
National Provider Identifier
1396021077
Registry record updated Sep 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
SNF12870961 Issued in FL
Legal business name
BLOUNTSTOWN REHABILITATION CENTER, LLC
Doing business as
River Valley Rehabilitation Center
Practice address
17884 NE Crozier St
Blountstown, FL 32424-1050
Phone
(850) 674-5464
Fax
(850) 674-9384
NPI assigned
Oct 26, 2011
Last updated
Sep 29, 2014By the provider in NPPES
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 FL
Skilled Nursing Facility 314000000X SNF12870961 FL Primary

Addresses

Primary practice location

17884 NE Crozier St
Blountstown, FL 32424-1050

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
004488900MedicaidFL

Other names 1

  • River Valley Rehabilitation Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120213000188 FL Part A Provider - Skilled Nursing Facility 8426215823 Practice locations: Blountstown, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396021077. Details of each certification follow.

Skilled nursing facility certification: CCN 105473

Legal name
BLOUNTSTOWN REHABILITATION CENTER, LLC
Doing business as
RIVER VALLEY REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 1, 1984
Last certification
Mar 27, 2025
Beds
150
Ownership / control type
Corporation
Multi-facility organization
Southern Healthcare Management
Most recent change of ownership
Feb 1, 2012
Organization structure
LLCProprietary
Incorporated
Oct 26, 2011 in DE
Enrollment address
17884 NE Crozier St
Blountstown, FL 32424-1050
Nursing home name
RIVER VALLEY REHABILITATION CENTER
Affiliated entity
SOVEREIGN HEALTHCARE HOLDINGS

Care Compare: Nursing home

Medicare Care Compare
Listed as
River Valley Rehabilitation CenterCCN 105473 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Nov 1, 1984
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
150112.4 residents per day on average
Chain
Sovereign Healthcare Holdings43 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Locations

17844 NE Crozier St
Blountstown, FL 32424

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
Susan Kaar Individual Managing Control - Governing BodyVP of Compliance and Quality MGMT Oct 1, 2003
Adp of the SNF Oct 1, 2003
Sovereign Healthcare Disbursements LLC Organization, Casselberry, FL LLC Adp of the SNF Feb 12, 2012
Fate Brown Individual Managing Control - Governing BodyVice President of Operations May 1, 2017
Adp of the SNF May 1, 2017
John Mangine Individual Operational/Managerial Control Jun 25, 2012
Adp of the SNF Jun 25, 2012
Indirect Ownership Interest Dec 31, 2015 3%
Southern Healthcare Management LLC Organization, Casselberry, FL LLC, Management services company, For-profit Operational/Managerial Control Feb 12, 2012
Adp of the SNF Dec 4, 2025
Trenton S Nobles Individual Operational/Managerial Control Dec 2, 2024
Adp of the SNF Dec 2, 2024
Michelle Kelly Individual Adp of the SNF Feb 1, 2018
Donald K Melton Individual Operational/Managerial Control Feb 1, 2012
Adp of the SNF Feb 1, 2012
William Notermann Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
Sovereign Healthcare Holdings LLC Organization, Atlanta, GA LLC, For-profit, Chain home office, Owned by another organization or individual Direct Ownership Interest Feb 1, 2012 100%
Iqbal Faruqui Individual Operational/Managerial Control Jan 1, 1996
Adp of the SNF Jan 1, 1996
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 Owned by another organization or individual Indirect Ownership Interest Nov 12, 2017 82.5%
Forvis Mazars LLP Organization, Springfield, MO Adp of the SNF Feb 1, 2012
Dawn Chery Individual Managing Control - Governing BodyChief Nursing Officer Jun 8, 2017
Adp of the SNF Jun 8, 2017
Cronquist 2015 Family TR Organization, Atlanta, GA Owned by another organization or individual Indirect Ownership Interest Dec 31, 2015 14.5%
HSP Panhandle, LLC Organization, Casselberry, FL LLC, Owned by another organization or individual 5% Or Greater Security Interest Feb 1, 2012 100%
Adp of the SNF Feb 1, 2012

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

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": "1319587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411948800000",
    "number": "1396021077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5887 GLENRIDGE DR NE",
            "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": "17884 NE CROZIER ST",
            "city": "BLOUNTSTOWN",
            "state": "FL",
            "postal_code": "324241050",
            "telephone_number": "850-674-5464",
            "fax_number": "850-674-9384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOUNTSTOWN REHABILITATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-26",
        "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": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF12870961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004488900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "River Valley Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blountstown, FL

Sources for this page

Verify at the official NPI Registry.