| Entity Name: | SOVEREIGN HEALTHCARE OF WEST PALM BEACH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 15 Jul 2003 (22 years ago) |
| Document Number: | M03000002335 |
| FEI/EIN Number | 200184869 |
| Mail Address: | 101 Sunnytown Road, Casselberry, FL, 32707, US |
| Address: | 2839 S. Seacrest Boulevard, Boynton Beach, FL, 33435, US |
| ZIP code: | 33435 |
| County: | Palm Beach |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487641189 | 2005-09-29 | 2014-09-24 | 5887 GLENRIDGE DR, ATLANTA, GA, 303285574, US | 2839 S SEACREST BLVD, BOYNTON BEACH, FL, 334357934, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 404-574-2100 |
| Fax | 4045742105 |
| Phone | +1 561-732-2462 |
| Fax | 5613698309 |
Authorized person
| Name | MR. R. MARK CRONQUIST |
| Role | MANAGER |
| Phone | 4045742100 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF1058096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 026361300 |
| State | FL |
| Issuer | VA |
| Number | V548P-1063 |
| Name | Role |
|---|---|
| COGENCY GLOBAL INC. | Agent |
| Name | Role |
|---|---|
| SOUTHERN HEALTHCARE MANAGEMENT, LLC | Manager |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000011695 | BOULEVARD REHABILITATION CENTER | ACTIVE | 2010-02-05 | 2025-12-31 | No data | 101 SUNNYTOWN RD, SUITE 201, CASSELBERRY, FL, 32707, US |
| G09048900142 | BOULEVARD MANOR NURSING AND REHAB CENTER | EXPIRED | 2009-02-17 | 2024-12-31 | No data | 2839 S. SEACREST BOULEVARD, BOYNTON BEACH, FL, 33435 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2017-04-05 | 2839 S. Seacrest Boulevard, Boynton Beach, FL 33435 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-07-07 | 115 North Calhoun St., Suite 4, Tallahassee, FL 32301 | No data |
| CHANGE OF MAILING ADDRESS | 2014-01-14 | 2839 S. Seacrest Boulevard, Boynton Beach, FL 33435 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-03-07 |
| ANNUAL REPORT | 2022-02-22 |
| ANNUAL REPORT | 2021-03-15 |
| ANNUAL REPORT | 2020-04-13 |
| ANNUAL REPORT | 2019-03-20 |
| ANNUAL REPORT | 2018-04-27 |
| AMENDED ANNUAL REPORT | 2017-04-05 |
| ANNUAL REPORT | 2017-03-10 |
| ANNUAL REPORT | 2016-03-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
