Moultrie Creek Nursing & Rehab Center
LBN: Sovereign Healthcare Of St. Augustine, Llc
Moultrie Creek Nursing & Rehab Center is an health care organization with primary practice located at 200 Mariner Health Way , St Augustine FL 32086-7226. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Skilled Nursing Facility, which is considered as the primary health care specialty.
Sovereign Healthcare Of St. Augustine, Llc can be contacted via phone (904) 797-1800, or through Cronquist, R. Mark via phone (404) 574-2100.
Contact Information
Primary practice address
200 Mariner Health Way
St Augustine FL 32086-7226
Phone: (904) 797-1800
Fax: (904) 797-1803
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Nursing & Custodial Care Facilities / Skilled Nursing Facility | 314000000X | SNF14600961 | Florida |
Profile Details
| NPI number | 1538156195 |
|---|---|
| LBN Legal business name | Sovereign Healthcare Of St. Augustine, Llc |
| DBA Doing business as | Moultrie Creek Nursing & Rehab Center |
| Authorized official | Cronquist, R. Mark |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Sep 29th, 2005 |
| Last updated | Sep 24th, 2014 - about 10 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1538156195 | NPPES |
| Florida | MEDICAID | 026355900 | |
| Florida | Other | V573P-6391 |
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