| Entity Name: | SOVEREIGN HEALTHCARE OF ST. AUGUSTINE, 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: | M03000002340 |
| FEI/EIN Number |
200185176
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Mail Address: | 101 Sunnytown Road, Casselberry, FL, 32707, US |
| Address: | 200 Mariner Health Way, St. Augustine, FL, 32086, US |
| ZIP code: | 32086 |
| County: | St. Johns |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538156195 | 2005-09-29 | 2014-09-24 | 5887 GLENRIDGE DR, SUITE 150, ATLANTA, GA, 303285574, US | 200 MARINER HEALTH WAY, ST AUGUSTINE, FL, 320867226, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 404-574-2100 |
| Fax | 4045742105 |
| Phone | +1 904-797-1800 |
| Fax | 9047971803 |
Authorized person
| Name | MR. R. MARK CRONQUIST |
| Role | MANAGER |
| Phone | 4045742100 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF14600961 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 026355900 |
| State | FL |
| Issuer | VA |
| Number | V573P-6391 |
| Name | Role |
|---|---|
| SOUTHERN HEALTHCARE MANAGEMENT, LLC | Manager |
| COGENCY GLOBAL INC. | Agent |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09048900148 | MOULTRIE CREEK NURSING AND REHAB CENTER | ACTIVE | 2009-02-17 | 2029-12-31 | - | 200 MARINER HEALTH WAY, ST. AUGUSTINE, FL, 32086 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2017-03-30 | 200 Mariner Health Way, St. Augustine, FL 32086 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2015-07-07 | 115 North Calhoun St., Suite 4, Tallahassee, FL 32301 | - |
| CHANGE OF MAILING ADDRESS | 2014-01-10 | 200 Mariner Health Way, St. Augustine, FL 32086 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-03-09 |
| ANNUAL REPORT | 2022-02-24 |
| ANNUAL REPORT | 2021-03-18 |
| 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 | 2015-01-09 |
| Contract Type | Award or IDV Flag | PIID | Start Date | Current End Date | Potential End Date | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DELIVERY ORDER | AWARD | VA24812JN033 | 2012-09-28 | 2012-09-30 | 2012-09-30 | |||||||||||||||||||||||||
|
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| Obligated Amount | 146347.75 |
| Current Award Amount | 280539.75 |
| Potential Award Amount | 280539.75 |
Description
| Title | IGF::CL::IGF CLOSELY ASSOCIATED COMMUNITY NURSING HOME BOA DO TO REPORT FY-12 1358 OBLIGATIONS TO FPDS. |
| NAICS Code | 623110: NURSING CARE FACILITIES |
| Product and Service Codes | Q402: MEDICAL- NURSING HOME CARE CONTRACTS |
Recipient Details
| Recipient | SOVEREIGN HEALTHCARE OF ST. AUGUSTINE, LLC |
| UEI | FKEUWDGFJHL3 |
| Recipient Address | 200 MARINER HEALTH WAY, SAINT AUGUSTINE, ST. JOHNS, FLORIDA, 320867226, UNITED STATES |
| Unique Award Key | CONT_AWD_VA573B0035_3600_VA248BO0143_3600 |
| Awarding Agency | Department of Veterans Affairs |
| Link | View Page |
Award Amounts
| Obligated Amount | 68386.00 |
| Current Award Amount | 68386.00 |
| Potential Award Amount | 68386.00 |
Description
| Title | NURSING HOME CARE |
| NAICS Code | 623110: NURSING CARE FACILITIES |
| Product and Service Codes | Q402: NURSING HOME CARE CONTRACTS |
Recipient Details
| Recipient | SOVEREIGN HEALTHCARE OF ST. AUGUSTINE, LLC |
| UEI | FKEUWDGFJHL3 |
| Recipient Address | 200 MARINER HEALTH WAY, SAINT AUGUSTINE, ST. JOHNS, FLORIDA, 320867226, UNITED STATES |
| Unique Award Key | CONT_AWD_VA573AB0002_3600_VA248BO0143_3600 |
| Awarding Agency | Department of Veterans Affairs |
| Link | View Page |
Award Amounts
| Obligated Amount | 65806.00 |
| Current Award Amount | 65806.00 |
| Potential Award Amount | 65806.00 |
Description
| Title | MOULTRIE CREEK NURSING HOME CARE 1ST QTR FY 2010 |
| NAICS Code | 623110: NURSING CARE FACILITIES |
| Product and Service Codes | Q402: NURSING HOME CARE CONTRACTS |
Recipient Details
| Recipient | SOVEREIGN HEALTHCARE OF ST. AUGUSTINE, LLC |
| UEI | FKEUWDGFJHL3 |
| Recipient Address | 200 MARINER HEALTH WAY, SAINT AUGUSTINE, ST. JOHNS, FLORIDA, 320867226, UNITED STATES |
| Unique Award Key | CONT_AWD_VA573AB0001_3600_VA248BO0143_3600 |
| Awarding Agency | Department of Veterans Affairs |
| Link | View Page |
Award Amounts
| Obligated Amount | 94519.97 |
| Current Award Amount | 94519.97 |
| Potential Award Amount | 94519.97 |
Description
| Title | MOULTRIE CREEK NURSING HOME CARE 1ST QTR FY 2010 |
| NAICS Code | 623110: NURSING CARE FACILITIES |
| Product and Service Codes | Q402: NURSING HOME CARE CONTRACTS |
Recipient Details
| Recipient | SOVEREIGN HEALTHCARE OF ST. AUGUSTINE, LLC |
| UEI | FKEUWDGFJHL3 |
| Recipient Address | 200 MARINER HEALTH WAY, SAINT AUGUSTINE, ST. JOHNS, FLORIDA, 320867226, UNITED STATES |
| Unique Award Key | CONT_IDV_VA248BO0143_3600 |
| Awarding Agency | Department of Veterans Affairs |
| Link | View Page |
Description
| Title | NURSING HOME CARE |
| NAICS Code | 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES) |
| Product and Service Codes | Q402: NURSING HOME CARE CONTRACTS |
Recipient Details
| Recipient | SOVEREIGN HEALTHCARE OF ST. AUGUSTINE, LLC |
| UEI | FKEUWDGFJHL3 |
| Legacy DUNS | 145886912 |
| Recipient Address | 200 MARINER HEALTH WAY, SAINT AUGUSTINE, 320867226, UNITED STATES |
Date of last update: 01 Apr 2025
Sources: Florida Department of State
