NPIMap

Organization Active NPI

Sovereign Healthcare of Jacksonville, LLC

Doing business as Jacksonville Nursing & Rehab Center

  • Skilled Nursing Facility
  • Jacksonville, FL
National Provider Identifier
1891782462
Registry record updated Sep 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
SNF13500963 Issued in FL
Legal business name
SOVEREIGN HEALTHCARE OF JACKSONVILLE, LLC
Doing business as
Jacksonville Nursing & Rehab Center
Practice address
4134 Dunn Ave
Jacksonville, FL 32218-4410
Phone
(904) 766-2297
Fax
(904) 766-9166
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 SNF13500963 FL Primary

Addresses

Primary practice location

4134 Dunn Ave
Jacksonville, FL 32218-4410

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
026349400MedicaidFL
V573P-6380OtherVA

Other names 1

  • Jacksonville 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
O20030908000024 FL Part A Provider - Skilled Nursing Facility 0143131458 Practice locations: Jacksonville, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891782462. Details of each certification follow.

Skilled nursing facility certification: CCN 105710

Legal name
SOVEREIGN HEALTHCARE OF JACKSONVILLE, LLC
Doing business as
JACKSONVILLE NURSING AND REHAB CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 31, 1990
Last certification
May 1, 2025
Beds
163
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Southern Healthcare Management
Most recent change of ownership
Oct 1, 2003
Organization structure
LLCProprietary
Enrollment address
4134 Dunn Ave
Jacksonville, FL 32218-4410
Nursing home name
JACKSONVILLE NURSING AND REHAB CENTER
Affiliated entity
SOVEREIGN HEALTHCARE HOLDINGS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Jacksonville Nursing and Rehab CenterCCN 105710 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Oct 31, 1990
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
163158.8 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
10D0889468Jacksonville Nursing and Rehab Center4134 Dunn Ave, Jacksonville, FL 32218Certificate of waiverJul 28, 2028

National Provider Directory

National Provider Directory

Locations

101 Sunnytown Rd
Ste 201
Casselberry, FL 32707
Phone (407) 830-1179

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 BodyVice President of Compliance and QM Oct 1, 2003
Adp of the SNF Oct 1, 2003
Sovereign Healthcare Disbursements LLC Organization, Casselberry, FL LLC Adp of the SNF May 19, 2009
FL Jacksonville 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
Fate Brown Individual Managing Control - Governing BodyVice President of Operations May 1, 2017
Adp of the SNF May 1, 2017
Raelyn Covington Individual Operational/Managerial Control Dec 11, 2023
Adp of the SNF Dec 11, 2023
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 Nov 20, 2025
Harpreet Singh Individual Operational/Managerial Control Dec 17, 2021
Adp of the SNF Dec 17, 2021
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
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 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 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 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 3

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": "1891782462",
    "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": "4134 DUNN AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322184410",
            "telephone_number": "904-766-2297",
            "fax_number": "904-766-9166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOVEREIGN HEALTHCARE OF JACKSONVILLE, 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": "SNF13500963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026349400",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VA",
            "identifier": "V573P-6380",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jacksonville Nursing & Rehab Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.