NPIMap

Organization Active NPI

Sovereign Healthcare of Atlantic Shores, LLC

Doing business as Atlantic Shores Nursing And Rehab Center

  • Skilled Nursing Facility
  • Melbourne, FL
National Provider Identifier
1831186477
Registry record updated Sep 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
SNF16420951 Issued in FL
Legal business name
SOVEREIGN HEALTHCARE OF ATLANTIC SHORES, LLC
Doing business as
Atlantic Shores Nursing And Rehab Center
Practice address
4251 Stack Blvd
Melbourne, FL 32901-8526
Phone
(321) 953-2219
Fax
(321) 953-2002
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 SNF16420951 FL Primary

Addresses

Primary practice location

4251 Stack Blvd
Melbourne, FL 32901-8526

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
V673P-5340OtherVA
026338900MedicaidFL

Other names 1

  • Atlantic Shores Nursing And 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
O20030912000003 FL Part A Provider - Skilled Nursing Facility 8921919184 Practice locations: Melbourne, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831186477. Details of each certification follow.

Skilled nursing facility certification: CCN 105904

Legal name
SOVEREIGN HEALTHCARE OF ATLANTIC SHORES LLC
Doing business as
ATLANTIC SHORES NURSING AND REHAB CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 31, 1996
Last certification
Sep 25, 2024
Beds
120
Ownership / control type
Corporation
Multi-facility organization
Southern Healthcare Management
Organization structure
LLCProprietary
Enrollment address
4251 Stack Blvd
Melbourne, FL 32901-8526
Nursing home name
ATLANTIC SHORES NURSING AND REHAB CENTER
Affiliated entity
SOVEREIGN HEALTHCARE HOLDINGS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Atlantic Shores Nursing and Rehab CenterCCN 105904 · All quality measures
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 31, 1996
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
120112.6 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
10D0907955Atlantic Shores Nursing and Rehab Center4251 Stack Blvd, Melbourne, FL 32901Certificate of waiverOct 25, 2027

National Provider Directory

National Provider Directory

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 Jan 1, 2025
Adp of the SNF Jan 1, 2025
Sovereign Healthcare Disbursements LLC Organization, Casselberry, FL LLC Adp of the SNF Jan 1, 2025
Henry Gerrity Individual Managing Control - Governing BodyVice President of Operations Jan 1, 2025
Adp of the SNF Jan 1, 2025
John Mangine Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
Indirect Ownership Interest Jan 1, 2025 3%
Southern Healthcare Management LLC Organization, Casselberry, FL LLC, Management services company Operational/Managerial Control Jan 1, 2025
Adp of the SNF Oct 10, 2025
FL Atlantic Shores 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
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
Johnny Wayne Guy Individual Operational/Managerial Control Jun 2, 2025
Adp of the SNF Jun 2, 2025
William Notermann Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
Anthony Jay Herzog Individual Operational/Managerial Control May 9, 2023
Adp of the SNF May 9, 2023
Sovereign Healthcare Holdings LLC Organization, Atlanta, GA Created for acquisition, LLC, Holding company, For-profit, Chain home office Direct Ownership Interest Jan 1, 2006 100%
Berkadia Commercial Mortgage LLC Organization, Horsham, PA LLC, 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 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 Jan 1, 2025
Adp of the SNF Jan 1, 2025
Health Services Properties LLC Organization, Casselberry, FL LLC, Owned by another organization or individual 5% Or Greater Security Interest May 19, 2009 100%
Cronquist 2015 Family TR Organization, Atlanta, GA 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 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": "1831186477",
    "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": "4251 STACK BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329018526",
            "telephone_number": "321-953-2219",
            "fax_number": "321-953-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOVEREIGN HEALTHCARE OF ATLANTIC SHORES, 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": "SNF16420951",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VA",
            "identifier": "V673P-5340",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026338900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Atlantic Shores Nursing And Rehab Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Melbourne, FL

Sources for this page

Verify at the official NPI Registry.