MEDICARE: SOVEREIGN HEALTHCARE OF ORANGE CITY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	SNF1464096	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	V573P-6387	OTHER	VA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285621987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOVEREIGN HEALTHCARE OF ORANGE CITY, LLC

Provider Business Mailing Address
First Line	:	5887 GLENRIDGE DR
Second Line	:	SUITE 150
City	:	ATLANTA
State	:	GA
Zip	:	30328-5574
Country	:	US
Telephone Number	:	404-574-2100
Fax Number	:	404-574-2105

Provider Business Practice Location Address
First Line	:	2810 ENTERPRISE RD
Second Line	:
City	:	DEBARY
State	:	FL
Zip	:	32713-2703
Country	:	US
Telephone Number	:	386-668-8818
Fax Number	:	386-668-6510

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. R. MARK CRONQUIST
Credential	:
Telephone Number	:	404-574-2100

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	09/24/2014

Similar Medicare Providers

1790152460 — WHITNEY WILSON APRN
Practice Location Address:

2810 ENTERPRISE RD
DEBARY, FL
32713-2703

Practice Phone: 207-775-4000
Practice Fax:

1760855183 — KELLIE OLIVER ARNP
Practice Location Address:

215 ACACIA RD
DEBARY, FL
32713-3801

Practice Phone: 386-956-8973
Practice Fax:

1134540743 — PATRICIA PEACE
Practice Location Address:

430 SUMMERHAVEN DR STE 200
DEBARY, FL
32713-2755

Practice Phone: 407-221-7463
Practice Fax:

1174474837 — DR. MARTHA EUGENIA GARCIA MD
Practice Location Address:

364 HINSDALE DR
DEBARY, FL
32713-4551

Practice Phone: 787-249-2015
Practice Fax:

1497747372 — DELTA HEALTH GROUP INC
Practice Location Address:

60 N HWY 17/92
DEBARY, FL
32713-2518

Practice Phone: 386-668-4426
Practice Fax: 386-668-4474

1932196052 — DR. KEVIN D. HUFFMAN D.O.
Practice Location Address:

432 N PINE MEADOW DR
DEBARY, FL
32713-2306

Practice Phone: 866-402-4250
Practice Fax:

Directions to “SOVEREIGN HEALTHCARE OF ORANGE CITY, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.