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SOVEREIGN HEALTHCARE OF MACCLENNY, LLC - Florida Company Profile

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Company Details

Entity Name: SOVEREIGN HEALTHCARE OF MACCLENNY, LLC
Jurisdiction: FLORIDA
Filing Type: Foreign Limited Liability Co.
Status: Active
Date Filed: 15 Jul 2003 (22 years ago)
Document Number: M03000002342
FEI/EIN Number 200185142
Mail Address: 101 Sunnytown Road, Casselberry, FL, 32707, US
Address: 755 South 5th Street, Macclenny, FL, 32063, US
ZIP code: 32063
City: Macclenny
County: Baker
Place of Formation: DELAWARE

Key Officers & Management

Role
Manager
Agent

Unique Entity ID

CAGE Code:
3ZQJ2
UEI Expiration Date:
2018-02-04

Business Information

Activation Date:
2017-02-04
Initial Registration Date:
2004-08-19

Commercial and government entity program

CAGE number:
3ZQJ2
Status:
Obsolete
Type:
Non-Manufacturer
CAGE Update Date:
2023-09-02
CAGE Expiration:
2022-02-04

Contact Information

POC:
DONALD K. MELTON

National Provider Identifier

NPI Number:
1720075351

Authorized Person:

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

Taxonomy:

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

Contacts:

Fax:
4045742105
Fax:
9042595381

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G09048900145 MACCLENNY NURSING AND REHAB CENTER ACTIVE 2009-02-17 2029-12-31 - 755 SOUTH 5TH STREET, MACCLENNY, FL, 32063

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2017-03-30 755 South 5th Street, Macclenny, FL 32063 -
REGISTERED AGENT ADDRESS CHANGED 2015-07-07 115 North Calhoun St., Suite 4, Tallahassee, FL 32301 -
CHANGE OF MAILING ADDRESS 2014-01-14 755 South 5th Street, Macclenny, FL 32063 -

Documents

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 2015-01-14

USAspending Awards / Contracts

Procurement Instrument Identifier:
VA24814A0010
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:
2013-11-01
Description:
IGF::OT::IGF FOR OTHER FUNCTIONS SOVEREIGN HEALTCARE OF MACCLENNY
Naics Code:
623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES)
Product Or Service Code:
Q402: MEDICAL- NURSING HOME CARE CONTRACTS
Procurement Instrument Identifier:
VA24812JN034
Award Or Idv Flag:
AWARD
Award Type:
DELIVERY ORDER
Action Obligation:
258243.46
Base And Exercised Options Value:
378105.46
Base And All Options Value:
378105.46
Awarding Agency Name:
Department of Veterans Affairs
Performance Start Date:
2012-09-28
Description:
IGF::CL::IGF CLOSELY ASSOCIATED COMMUNITY NURSING HOME BOA DO TO REPORT FY-12 1358 OBLIGATIONS TO FPDS. MACCLENNY NURSING HOME
Naics Code:
623110: NURSING CARE FACILITIES
Product Or Service Code:
Q402: MEDICAL- NURSING HOME CARE CONTRACTS
Procurement Instrument Identifier:
VA573B0034
Award Or Idv Flag:
AWARD
Award Type:
DELIVERY ORDER
Action Obligation:
38663.00
Base And Exercised Options Value:
38663.00
Base And All Options Value:
38663.00
Awarding Agency Name:
Department of Veterans Affairs
Performance Start Date:
2010-10-19
Description:
MACCLENNY NURSING HOME
Naics Code:
623110: NURSING CARE 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