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1 LBJ SR DRIVE
FORT WALTON BEACH, FL 32548
Phone: (850) 863-2066
County: Okaloosa

Mailing Address

1 LBJ SR DRIVE
FORT WALTON BEACH, FL 32548
County: Okaloosa
Website: http://www.fortwaltonrehab.com

Emergency Actions:

None
Facility/Provider Type: Nursing Home
Administrator: ERIC BRUN
Financial Officer: DONALD K MELTON
Owner/Licensee: FORT WALTON REHABILITATION CENTER, LLC
Owner/Licensee Since: 2/1/2012
NamePositionOwnership
SOVEREIGN HEALTHCARE HOLDINGS, LLC 100%
Profit Status: For-Profit
Management Company: SOUTHERN HEALTHCARE MANAGEMENT LLC
Manager Since: 1/31/2012
NamePositionOwnership
JOHN JOSEPH NOTERMANBOARD MEMBER/OFFICER50%
ROYCE MARK CRONQUISTBOARD MEMBER/OFFICER46%
Licensed Beds: 120
Bed Types:
Community Beds : 120
Sheltered Beds : 0
Pediatric Beds : 0
Private Rooms : 40
2-Bed Rooms : 40
3-Bed Rooms : 0
4-Bed Rooms : 0
AHCA Number (File Number): 14605
AHCA Field Office: 01
License Number: 11610951
Current License Effective: 2/1/2018
Expires: 1/31/2020
License Status: LICENSED

Compare Quality and/or Pricing:

Services/Characteristics:

Current Daily Rate ($) of Semi-Private Room :  $240.00
Occupancy/Occupancy Rate :  103 / 85.81%
Continuing Care Retirement Community :  No
Adult Day Care Services :  No
Languages Spoken :  Filipino, German, Sign Language, Spanish
Payment Forms Accepted :  CHAMPUS/TRICARE, Insurance and/or HMO, Medicaid, Medicare, Workers Compensation
Special Programs and Services :  24 hr Onsite RN Coverage, Alzheimer's, HIV Care, Hospice Care, Respite, Tracheotomy, Weight Training

Legal Actions

Date ImposedCase #Case TypeViolationFine Amount
11/09/2017 2017012117 Rule Variance/WaiverAdministrative Rule N/A
Please note the legal actions above may have been issued to a prior owner. The Final Order displays the name of the licensee responsible for the legal action that was taken.

Consumer Guides:



Attn Providers: Requests for changes in data must be sent in writing to the AHCA licensing office.
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