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  5. SOVEREIGN HEALTHCARE OF MACCLENNY, LLC

SOVEREIGN HEALTHCARE OF MACCLENNY, LLC - Florida Company Profile

Company Details

Entity Name: SOVEREIGN HEALTHCARE OF MACCLENNY, 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: M03000002342
FEI/EIN Number 200185142

Federal Employer Identification (FEI) Number assigned by the IRS.
Mail Address: 101 Sunnytown Road, Casselberry, FL, 32707, US
Address: 755 South 5th Street, Macclenny, FL, 32063, US
ZIP code: 32063
County: Baker
Place of Formation: DELAWARE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1720075351 2005-09-29 2014-09-24 5887 GLENRIDGE DR, SUITE 150, ATLANTA, GA, 303285574, US 755 S 5TH ST, MACCLENNY, FL, 320632685, US

Contacts
Phone +1 404-574-2100
Fax 4045742105
Phone +1 904-259-4873
Fax 9042595381

Authorized person
Name MR. R. MARK CRONQUIST
Role MANAGER
Phone 4045742100

Taxonomy
Taxonomy Code 314000000X - Skilled Nursing Facility
License Number SNF1222096
State FL
Is Primary Yes

Other Provider Identifiers
Issuer VA
Number V573P-6392
Issuer MEDICAID
Number 026351600
State FL

Key Officers & Management

Name Role
SOUTHERN HEALTHCARE MANAGEMENT, LLC Manager
COGENCY GLOBAL INC. Agent

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

Contract Type Award or IDV Flag PIID Start Date Current End Date Potential End Date
DELIVERY ORDER AWARD VA24812JN034 2012-09-28 2012-09-30 2013-10-31
Unique Award Key CONT_AWD_VA24812JN034_3600_VA248BO0096_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Award Amounts
Obligated Amount 258243.46
Current Award Amount 378105.46
Potential Award Amount 378105.46

Description
Title 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 and Service Codes Q402: MEDICAL- NURSING HOME CARE CONTRACTS

Recipient Details
Recipient SOVEREIGN HEALTHCARE OF MACCLENNY, LLC
UEI NQXJYNABGU88
Recipient Address 755 SOUTH 5TH ST, MACCLENNY, BAKER, FLORIDA, 320632685, UNITED STATES
DELIVERY ORDER AWARD VA573B0034 2010-10-19 2010-10-31 2013-10-31
Unique Award Key CONT_AWD_VA573B0034_3600_VA248BO0096_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Award Amounts
Obligated Amount 38663.00
Current Award Amount 38663.00
Potential Award Amount 38663.00

Description
Title MACCLENNY NURSING HOME
NAICS Code 623110: NURSING CARE FACILITIES
Product and Service Codes Q402: NURSING HOME CARE CONTRACTS

Recipient Details
Recipient SOVEREIGN HEALTHCARE OF MACCLENNY, LLC
UEI NQXJYNABGU88
Recipient Address 755 SOUTH 5TH ST, MACCLENNY, BAKER, FLORIDA, 320632685, UNITED STATES
DELIVERY ORDER AWARD VA573AB0110 2009-11-01 2010-10-31 2013-10-31
Unique Award Key CONT_AWD_VA573AB0110_3600_VA248BO0096_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Award Amounts
Obligated Amount 81199.00
Current Award Amount 81199.00
Potential Award Amount 81199.00

Description
Title MACCLENNY NURSING HOME
NAICS Code 623110: NURSING CARE FACILITIES
Product and Service Codes Q402: NURSING HOME CARE CONTRACTS

Recipient Details
Recipient SOVEREIGN HEALTHCARE OF MACCLENNY, LLC
UEI NQXJYNABGU88
Recipient Address 755 SOUTH 5TH ST, MACCLENNY, BAKER, FLORIDA, 320632685, UNITED STATES
DELIVERY ORDER AWARD VA573AB9024 2009-04-01 2009-09-30 2009-09-30
Unique Award Key CONT_AWD_VA573AB9024_3600_VA248BO0096_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Award Amounts
Obligated Amount 121533.95
Current Award Amount 215539.00
Potential Award Amount 215539.00

Description
Title MACCLENNY NURSING HOME 3RD & 4TH QTR EXPENDITURES FY 09
NAICS Code 623110: NURSING CARE FACILITIES
Product and Service Codes Q402: NURSING HOME CARE CONTRACTS

Recipient Details
Recipient SOVEREIGN HEALTHCARE OF MACCLENNY, LLC
UEI NQXJYNABGU88
Recipient Address 755 SOUTH 5TH ST, MACCLENNY, BAKER, FLORIDA, 320632685, UNITED STATES
DELIVERY ORDER AWARD VA573B0002 2008-11-01 2010-10-31 2013-10-31
Unique Award Key CONT_AWD_VA573B0002_3600_VA248BO0096_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Award Amounts
Obligated Amount 81199.00
Current Award Amount 81199.00
Potential Award Amount 81199.00

Description
Title MACCLENNY NURSING HOME
NAICS Code 623110: NURSING CARE FACILITIES
Product and Service Codes Q402: NURSING HOME CARE CONTRACTS

Recipient Details
Recipient SOVEREIGN HEALTHCARE OF MACCLENNY, LLC
UEI NQXJYNABGU88
Recipient Address 755 SOUTH 5TH ST, MACCLENNY, BAKER, FLORIDA, 320632685, UNITED STATES
- IDV VA248BO0096 2008-11-01 - -
Unique Award Key CONT_IDV_VA248BO0096_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Award Amounts
Obligated Amount 0.00
Potential Award Amount 215539.00

Description
Title MACCLENNY NURSING HOME
NAICS Code 623110: NURSING CARE FACILITIES
Product and Service Codes Q402: NURSING HOME CARE CONTRACTS

Recipient Details
Recipient SOVEREIGN HEALTHCARE OF MACCLENNY, LLC
UEI NQXJYNABGU88
Recipient Address 755 SOUTH 5TH ST, MACCLENNY, BAKER, FLORIDA, 320632685, UNITED STATES
DELIVERY ORDER AWARD VA573AB9010 2008-10-01 2009-03-31 2009-03-31
Unique Award Key CONT_AWD_VA573AB9010_3600_VA248BO0096_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Award Amounts
Obligated Amount 94005.05
Current Award Amount 94005.05
Potential Award Amount 94005.05

Description
Title MACCLENNY NURSING HOME 1ST & 2ND QTR EXPENDITURES FY 09
NAICS Code 623110: NURSING CARE FACILITIES
Product and Service Codes Q402: NURSING HOME CARE CONTRACTS

Recipient Details
Recipient SOVEREIGN HEALTHCARE OF MACCLENNY, LLC
UEI NQXJYNABGU88
Recipient Address 755 SOUTH 5TH ST, MACCLENNY, BAKER, FLORIDA, 320632685, UNITED STATES
DO AWARD VA573AB8008 2007-10-01 2008-09-30 2008-09-30
Unique Award Key CONT_AWD_VA573AB8008_3600_V573P6392_3600
Awarding Agency Department of Veterans Affairs
Link View Page

Description
Title MACCLENNY NSH HOME FY 08 EXPENDITURES
NAICS Code 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES)
Product and Service Codes Q402: NURSING HOME CARE CONTRACTS

Recipient Details
Recipient SOVEREIGN HEALTHCARE OF MACCLENNY, LLC
UEI NQXJYNABGU88
Legacy DUNS 145886672
Recipient Address 755 S 5TH STREET, MACCLENNY, 320632685, UNITED STATES

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Date of last update: 01 Apr 2025

Sources: Florida Department of State

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