| Entity Name: | SOVEREIGN HEALTHCARE OF PORT ORANGE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 15 Jul 2003 (22 years ago) |
| Document Number: | M03000002338 |
| FEI/EIN Number |
200186136
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Mail Address: | 101 Sunnytown Road, Casselberry, FL, 32707, US |
| Address: | 5600 Victoria Gardens Blvd., Port Orange, FL, 32127, US |
| ZIP code: | 32127 |
| County: | Volusia |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710974423 | 2005-09-29 | 2014-09-24 | 5887 GLENRIDGE DR, SUITE 150, ATLANTA, GA, 303285574, US | 5600 VICTORIA GARDENS BLVD, PORT ORANGE, FL, 321277914, US | |||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||
| Phone | +1 404-574-2100 |
| Fax | 4045742105 |
| Phone | +1 386-760-7773 |
| Fax | 3867608949 |
Authorized person
| Name | MR. R. MARK CRONQUIST |
| Role | MANAGER |
| Phone | 4045742100 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF130471000 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 026350800 |
| State | FL |
| Issuer | VA |
| Number | V573P-6386 |
| Name | Role |
|---|---|
| COGENCY GLOBAL INC. | Agent |
| SOUTHERN HEALTHCARE MANAGEMENT, LLC | Manager |
| 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 |
| 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 | - |
| 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 |
| Inspection Nr | Report ID | Date Opened | Site Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 345485668 | 0419700 | 2021-08-17 | 5600 VICTORIA GARDENS BLVD, PORT ORANGE, FL, 32127 | |||||||||||||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||||||||||||
| Type | Referral |
| Activity Nr | 1796231 |
| Health | Yes |
| Type | Referral |
| Activity Nr | 1802055 |
| Health | Yes |
| Type | Referral |
| Activity Nr | 1794984 |
| Health | Yes |
| Type | Referral |
| Activity Nr | 1794960 |
| Health | Yes |
Date of last update: 03 May 2025
Sources: Florida Department of State
