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NPI Code Detail

MEDICARE: SOVEREIGN HEALTHCARE OF WEST PALM BEACH, LLC

MEDICARE: SOVEREIGN HEALTHCARE OF WEST PALM BEACH, 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
1314000000XSkilled Nursing FacilitySNF1058096FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2V548P-1063OTHERVA
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487641189
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOVEREIGN HEALTHCARE OF WEST PALM BEACH, LLC
Provider Business Mailing Address
First Line : 5887 GLENRIDGE DR
Second Line :
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 : 2839 S SEACREST BLVD
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33435-7934
Country : US
Telephone Number : 561-732-2462
Fax Number : 561-369-8309
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

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Directions to “SOVEREIGN HEALTHCARE OF WEST PALM BEACH, LLC ” Practice Location

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