SOVEREIGN HEALTHCARE OF ATLANTIC SHORES, LLC (NPI# 1831186477) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831186477 |
| Entity Type | Organization |
| Organization Name | SOVEREIGN HEALTHCARE OF ATLANTIC SHORES, LLC |
| Other Organization Name | ATLANTIC SHORES NURSING AND REHAB CENTER |
| Practice Address |
4251 Stack Blvd Melbourne FL 32901-8526 |
| Mailing Address |
5887 Glenridge Dr Suite 150 Atlanta GA 30328-5574 |
| Practice Telephone | 3219532219 |
| Practice Fax Number | 3219532002 |
| Mailing Telephone | 4045742100 |
| Mailing Fax Number | 4045742105 |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2014-09-24 |
| Authorized Official Name | MR. R. MARK CRONQUIST (MANAGER) |
| Authorized Official Telephone | 4045742100 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | SNF16420951 | FL | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 026338900 | 05 | |
| VA | V673P-5340 | 01 |
| Other Name | Type Code |
|---|---|
| Atlantic Shores Nursing And Rehab Center | Doing Business As Name - Organization |
| Street Address |
4251 STACK BLVD |
| City | MELBOURNE |
| State | FL |
| Zip Code | 32901-8526 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356974588 | Brandon Smith | Nurse Practitioner | 4251 Stack Blvd, Melbourne, FL 32901-8526 | 2020-02-17 |
| 1912488719 | Danielle N Carter | Physical Therapist | 4251 Stack Blvd, Melbourne, FL 32901-8526 | 2018-08-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467062943 | George Pappas | Anesthesiologist Assistant | 1775 W. Hibiscus Blvd., Ste 215, Melbourne, FL 32901 | 2020-08-09 |
| 1124676820 | Abbi Dell Lee | Behavioral Analyst | 3251 Engineering St, Melbourne, FL 32901 | 2019-08-27 |
| 1750856878 | Jeffrey Michael Cavanagh | Behavior Technician | 3251 Engineering Street, Melbourne, FL 32901 | 2018-10-04 |
| 1740766021 | Amanda Miller | Behavior Technician | 1885 W Hibiscus Blvd, Melbourne, FL 32901 | 2018-07-19 |
| 1396244406 | Dragen II LLC | Urology | 129 W Hibiscus Blvd Ste D, Melbourne, FL 32901 | 2018-02-03 |
| 1225550692 | Cabrit Psychotherapy Services LLC | Marriage & Family Therapist | 100 Rialto Place, Suite 700, Melbourne, FL 32901 | 2017-07-07 |
| 1487188058 | Project Response, Inc. | Clinic/Center | 747 S. Apollo Boulevard, Melbourne, FL 32901 | 2017-04-20 |
| 1184174575 | Paulette Swanson | Physical Therapist | 611 East Sheridan Rd, Melbourne, FL 32901 | 2016-10-10 |
| 1841747839 | Nicholas Wilson | Social Worker | 3661 S. Babcock St., Melbourne, FL 32901 | 2016-09-07 |
| 1467804278 | Nickolas Hetherington | Occupational Therapist | 1900 S Harbor City Blvd Ste 108, Melbourne, FL 32901 | 2016-07-05 |
| Find all providers in zip 32901 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952727521 | Mlbnc, Inc. | Skilled Nursing Facility | 1506 E Main St, Melbourne, AR 72556-9315 | 2014-03-06 |
| 1255605499 | Gassville Therapy & Living Center, Inc. | Skilled Nursing Facility | 600 North Main Suite A, Melbourne, AR 72556 | 2012-03-06 |
| 1487718680 | Avante At Melbourne, Inc. | Skilled Nursing Facility | 1420 Oak St, Melbourne, FL 32901-3113 | 2006-12-21 |
| 1861418790 | Melwood Nursing Center, L.L.C. | Skilled Nursing Facility | 606 E Sheridan Rd, Melbourne, FL 32901-3227 | 2006-07-14 |
| 1053300657 | Pnrc, Inc. | Skilled Nursing Facility | 1114 East Main, Melbourne, AR 72556 | 2005-10-17 |
| 1376530956 | Melbourne Terrace Rcc, LLC | Skilled Nursing Facility | 251 E Florida Ave, Melbourne, FL 32901-8303 | 2005-09-29 |
| 1245222157 | Delta Health Group Inc | Skilled Nursing Facility | 1415 S Hickory St, Melbourne, FL 32901-3225 | 2005-08-17 |
| 1255605598 | Twin Lakes Therapy & Living Center, Inc. | Skilled Nursing Facility | 600 North Main, Suite A, Melbourne, AR 72556 | 2012-03-05 |
| 1205100567 | Buffalo River Therapy & Living Center, Inc. | Skilled Nursing Facility | 600 North Main, Suite A, Melbourne, AR 72556 | 2012-03-05 |
| 1417116252 | Sf Carnegie LLC | Skilled Nursing Facility | 1415 S Hickory St, Melbourne, FL 32901-3225 | 2008-06-06 |
| Find all providers in MELBOURNE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.