NPIMap

Organization Active NPI

Sovereign Healthcare of Bonifay, LLC

  • Skilled Nursing Facility
  • Bonifay, FL
National Provider Identifier
1477540037
Registry record updated Sep 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
SNF10570961 Issued in FL
Legal business name
SOVEREIGN HEALTHCARE OF BONIFAY, LLC
Practice address
306 W Brock Ave
Bonifay, FL 32425-2904
Phone
(850) 547-9289
Fax
(850) 547-2575
NPI assigned
Sep 29, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X SNF10570961 FL Primary

Addresses

Primary practice location

306 W Brock Ave
Bonifay, FL 32425-2904

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
026344300MedicaidFL

Other names 1

  • Bonifay Nursing & Rehab Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030911000011 FL Part A Provider - Skilled Nursing Facility 6204747462 Practice locations: Bonifay, FL

Skilled nursing facility certification: CCN 105624

Legal name
SOVEREIGN HEALTHCARE OF BONIFAY LLC
Doing business as
BONIFAY NURSING AND REHAB CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1989
Last certification
Oct 15, 2024
Beds
180
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Southern Health Care Management
Organization structure
LLCProprietary
Enrollment address
306 W Brock Ave
Bonifay, FL 32425-2904
Nursing home name
BONIFAY NURSING AND REHAB CENTER
Affiliated entity
SOVEREIGN HEALTHCARE HOLDINGS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Bonifay Nursing and Rehab CenterCCN 105624
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 1, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
180145.9 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
10D0995983Bonifay Nursing and Rehab Center306 West Brock Ave, Bonifay, FL 32425Certificate of waiverFeb 5, 2028

National Provider Directory

National Provider Directory
Tax ID family
Bonifay NSG Rehab2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 19

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
Mohammad Yunus Individual Operational/Managerial Control Jan 1, 2000
Adp of the SNF Jan 1, 2000
Robert Brown Individual Operational/Managerial Control Oct 10, 2022
Adp of the SNF Oct 10, 2022
Sovereign Healthcare Disbursements LLC Organization, Casselberry, FL LLC Adp of the SNF May 19, 2009
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 Jun 25, 2012 3%
Southern Healthcare Management LLC Organization, Casselberry, FL LLC, Management services company, For-profit Operational/Managerial Control Oct 1, 2003
Adp of the SNF Oct 29, 2025
Michelle Kelly Individual Adp of the SNF Feb 1, 2018
Donald K Melton Individual Operational/Managerial Control Feb 15, 2009
Adp of the SNF Feb 15, 2009
FL Bonifay Holdings, LLC Organization, Miami, FL LLC, Owned by another organization or individual 5% Or Greater Security Interest May 19, 2009 100%
Adp of the SNF May 19, 2009
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 Oct 1, 2003 100%
Berkadia Commercial Mortgage LLC Organization, Horsham, PA Financial institution 5% Or Greater Security Interest Sep 23, 2014 100%
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 Jan 1, 2025
Dawn Chery Individual Managing Control - Governing BodyChief Nursing Officer Jun 8, 2017
Adp of the SNF Jun 8, 2017
Health Services Properties LLC Organization, Casselberry, FL LLC, Owned by another organization or individual 5% Or Greater Security Interest May 19, 2009 100%
Adp of the SNF May 19, 2009
Cronquist 2015 Family TR Organization, Atlanta, GA For-profit, Owned by another organization or individual Indirect Ownership Interest Dec 31, 2015 14.5%

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": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411516800000",
    "number": "1477540037",
    "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": "306 W BROCK AVE",
            "city": "BONIFAY",
            "state": "FL",
            "postal_code": "324252904",
            "telephone_number": "850-547-9289",
            "fax_number": "850-547-2575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOVEREIGN HEALTHCARE OF BONIFAY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2014-09-24",
        "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": "SNF10570961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026344300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bonifay Nursing & Rehab Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bonifay, FL

Sources for this page

Verify at the official NPI Registry.