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SOVEREIGN HEALTHCARE OF PORT ORANGE, LLC - Florida Company Profile

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Company Details

Entity Name: SOVEREIGN HEALTHCARE OF PORT ORANGE, LLC
Jurisdiction: FLORIDA
Filing Type: Foreign Limited Liability Co.
Status: Active
Date Filed: 15 Jul 2003 (22 years ago)
Document Number: M03000002338
FEI/EIN Number 200186136
Mail Address: 101 Sunnytown Road, Casselberry, FL, 32707, US
Address: 5600 Victoria Gardens Blvd., Port Orange, FL, 32127, US
ZIP code: 32127
City: Port Orange
County: Volusia
Place of Formation: DELAWARE

Key Officers & Management

Role
Agent
Manager

Unique Entity ID

CAGE Code:
3ZQJ0
UEI Expiration Date:
2018-02-04

Business Information

Doing Business As:
PORT ORANGE NURSING & REHAB CENTER
Division Name:
PORT ORANGE
Activation Date:
2017-02-04
Initial Registration Date:
2004-08-19

Commercial and government entity program

CAGE number:
3ZQJ0
Status:
Obsolete
Type:
Non-Manufacturer
CAGE Update Date:
2022-02-05
CAGE Expiration:
2022-02-04

Contact Information

POC:
DONALDDONALD K. MELTON

National Provider Identifier

NPI Number:
1710974423

Authorized Person:

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

Taxonomy:

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

Contacts:

Fax:
4045742105
Fax:
3867608949

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G09048900152 PORT ORANGE NURSING AND REHAB CENTER ACTIVE 2009-02-17 2029-12-31 - 5600 VICTORIA GARDENS BLVD., SUITE 201, PORT ORANGE, FL, 32127

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2017-03-30 5600 Victoria Gardens Blvd., Port Orange, FL 32127 -
REGISTERED AGENT ADDRESS CHANGED 2015-07-07 115 North Calhoun St., Suite 4, Tallahassee, FL 32301 -
CHANGE OF MAILING ADDRESS 2014-01-10 5600 Victoria Gardens Blvd., Port Orange, FL 32127 -

Documents

Name Date
ANNUAL REPORT 2024-02-05
ANNUAL REPORT 2023-03-08
ANNUAL REPORT 2022-02-18
ANNUAL REPORT 2021-03-15
ANNUAL REPORT 2020-04-13
ANNUAL REPORT 2019-03-21
ANNUAL REPORT 2018-04-27
ANNUAL REPORT 2017-03-30
ANNUAL REPORT 2016-03-25
ANNUAL REPORT 2015-01-14

OSHA's Inspections within Industry

Inspection Summary

Date:
2021-08-17
Type:
Referral
Address:
5600 VICTORIA GARDENS BLVD, PORT ORANGE, FL, 32127
Safety Health:
Health
Scope:
Partial

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Date of last update: 03 Aug 2025

Sources: Florida Department of State