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SOVEREIGN HEALTHCARE OF TUSKAWILLA, LLC - Florida Company Profile

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Company Details

Entity Name: SOVEREIGN HEALTHCARE OF TUSKAWILLA, LLC
Jurisdiction: FLORIDA
Filing Type: Foreign Limited Liability Co.
Status: Active
Date Filed: 15 Jul 2003 (22 years ago)
Document Number: M03000002330
FEI/EIN Number 200186229
Address: 1024 Willa Springs Drive, Winter Springs, FL, 32708, US
Mail Address: 101 Sunnytown Road, Casselberry, FL, 32707, US
ZIP code: 32708
City: Winter Springs
County: Seminole
Place of Formation: DELAWARE

Key Officers & Management

Role
Manager
Agent

Unique Entity ID

CAGE Code:
30NX7
UEI Expiration Date:
2018-02-04

Business Information

Doing Business As:
TUSKAWILLA NURSING AND REHAB CENTER
Activation Date:
2017-02-04
Initial Registration Date:
2004-08-30

Commercial and government entity program

CAGE number:
30NX7
Status:
Obsolete
Type:
Non-Manufacturer
CAGE Update Date:
2022-02-05
CAGE Expiration:
2022-02-04

Contact Information

POC:
DONALD K. MELTON

National Provider Identifier

NPI Number:
1346237963

Authorized Person:

Name:
MR. R. MARK CRONQUIST
Role:
MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
314000000X - Skilled Nursing Facility
Is Primary:
Yes

Contacts:

Fax:
4045742105
Fax:
4076998269

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G09048900155 TUSKAWILLA NURSING AND REHAB CENTER ACTIVE 2009-02-17 2029-12-31 - 1024 WILLA SPRINGS DRIVE, WINTER SPRINGS, FL, 32708

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2017-03-30 1024 Willa Springs Drive, Winter Springs, FL 32708 -
REGISTERED AGENT ADDRESS CHANGED 2015-07-07 115 North Calhoun St., Suite 4, Tallahassee, FL 32301 -
CHANGE OF MAILING ADDRESS 2014-01-10 1024 Willa Springs Drive, Winter Springs, FL 32708 -

Documents

Name Date
ANNUAL REPORT 2024-02-05
ANNUAL REPORT 2023-03-08
ANNUAL REPORT 2022-02-24
ANNUAL REPORT 2021-03-15
ANNUAL REPORT 2020-04-14
ANNUAL REPORT 2019-03-21
ANNUAL REPORT 2018-04-27
ANNUAL REPORT 2017-03-30
ANNUAL REPORT 2016-03-30
ANNUAL REPORT 2015-01-13

USAspending Awards / Contracts

Procurement Instrument Identifier:
VA248BO0108
Award Or Idv Flag:
IDV
Action Obligation:
0.00
Base And Exercised Options Value:
0.00
Base And All Options Value:
0.00
Awarding Agency Name:
Department of Veterans Affairs
Performance Start Date:
2009-06-23
Description:
COMMUNITY NURSING HOME CARE, TUSKAWILLA
Naics Code:
623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES)
Product Or Service Code:
Q402: NURSING HOME CARE CONTRACTS
Procurement Instrument Identifier:
V673P5627FY08
Award Or Idv Flag:
AWARD
Award Type:
DO
Action Obligation:
16508.12
Base And Exercised Options Value:
16508.12
Base And All Options Value:
16508.12
Awarding Agency Name:
Department of Veterans Affairs
Performance Start Date:
2007-10-01
Description:
COMMUNITY NURSING HOME EXPENDITURE - FY08
Naics Code:
623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES)
Product Or Service Code:
Q402: NURSING HOME CARE CONTRACTS

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Date of last update: 01 Aug 2025

Sources: Florida Department of State