NPIMap

Organization Active NPI

Sovereign Healthcare of West Palm Beach, LLC

Doing business as Boulevard Rehabilitation Center

  • Skilled Nursing Facility
  • Boynton Beach, FL
National Provider Identifier
1487641189
Registry record updated Sep 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
SNF1058096 Issued in FL
Legal business name
SOVEREIGN HEALTHCARE OF WEST PALM BEACH, LLC
Doing business as
Boulevard Rehabilitation Center
Practice address
2839 S Seacrest Blvd
Boynton Beach, FL 33435-7934
Phone
(561) 732-2462
Fax
(561) 369-8309
NPI assigned
Sep 29, 2005
Last updated
Sep 24, 2014By the provider in NPPES
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 SNF1058096 FL Primary

Addresses

Primary practice location

2839 S Seacrest Blvd
Boynton Beach, FL 33435-7934

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
V548P-1063OtherVA
026361300MedicaidFL

Other names 1

  • Boulevard 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
O20030911000007 FL Part A Provider - Skilled Nursing Facility 7416868666 Practice locations: Boynton Beach, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487641189. Details of each certification follow.

Skilled nursing facility certification: CCN 105067

Legal name
SOVEREIGN HEALTHCARE OF WEST PALM BEACH LLC
Doing business as
BOULEVARD REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 16, 1975
Last certification
Feb 27, 2025
Beds
167
Ownership / control type
Corporation
Multi-facility organization
Southern Healthcare Management Group
Most recent change of ownership
Oct 1, 2003
Organization structure
LLCProprietary
Enrollment address
2839 S Seacrest Blvd
Boynton Beach, FL 33435-7934
Nursing home name
BOULEVARD REHABILITATION CENTER
Affiliated entity
SOVEREIGN HEALTHCARE HOLDINGS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Boulevard Rehabilitation CenterCCN 105067 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jul 16, 1975
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
167126.2 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
10D0678513Boulevard Rehabilitation Center2839 S Seacrest Blvd, Boynton Beach, FL 33435Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

5887 Glenridge Dr
Sandy Springs, GA 30328
Phone (404) 390-4098

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

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 May 19, 2009
Adp of the SNF May 19, 2009
Sovereign Healthcare Disbursements LLC Organization, Casselberry, FL LLC Adp of the SNF May 19, 2009
John Mangine Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
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 Nov 20, 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
William Notermann Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
Charles Bell Individual Managing Control - Governing BodyVice President of Operations Sep 15, 2016
Adp of the SNF Sep 15, 2016
Sovereign Healthcare Holdings LLC Organization, Atlanta, GA LLC, For-profit, Chain home office, Owned by another organization or individual Direct Ownership Interest May 19, 2009 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 Oct 11, 2017
Indirect Ownership Interest Dec 31, 2015 14.5%
Yanitza Rodriguez Individual Operational/Managerial Control Jun 1, 2025
Adp of the SNF Jun 1, 2025
FL Boulevard Manor 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
John J Notermann Business TR Organization, Atlanta, GA Owned by another organization or individual Indirect Ownership Interest Oct 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 Owned by another organization or individual Indirect Ownership Interest Dec 31, 2015 14.5%
Tim Waskiewicz Individual Operational/Managerial Control Jul 21, 2023
Adp of the SNF Jul 21, 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

Affiliated clinicians 4

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": "1487641189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5887 GLENRIDGE DR",
            "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": "2839 S SEACREST BLVD",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334357934",
            "telephone_number": "561-732-2462",
            "fax_number": "561-369-8309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOVEREIGN HEALTHCARE OF WEST PALM BEACH, 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": "SNF1058096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VA",
            "identifier": "V548P-1063",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026361300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boulevard Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boynton Beach, FL

Sources for this page

Verify at the official NPI Registry.