Provider Profile
ATLANTIC SHORES NURSING AND REHAB CENTER
Nursing Home
FACILITY PROFILE
Street Address
- 4251 STACK BLVD
MELBOURNE, FL 32901
County: Brevard - Phone: (321) 953-2219
Mailing Address
- 4251 STACK BLVD
MELBOURNE, FL 32901
County: Brevard - Phone: (321) 953-2219
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Inspection ReportsInspection Details
Consumer Guides
Long-Term CarePatient Safety
Health Care Advance Directives
Nursing Home Guide
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Facility Information:
| Facility/Provider Type: | Nursing Home | |||||||||
| Administrator: | PATRICIA J. FOSTER | |||||||||
| Financial Officer: | DONALD K MELTON | |||||||||
| Owner/Licensee: | SOVEREIGN HEALTHCARE OF ATLANTIC SHORES, LLC | |||||||||
| Owner/Licensee Since: | 10/1/2003 | |||||||||
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| Profit Status: | For-Profit | |||||||||
| Management Company: | SOUTHERN HEALTHCARE MANAGEMENT LLC | |||||||||
| Manager Since: | 10/1/2003 | |||||||||
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| Licensed Beds: | 120 | |||||||||
| Bed Types: | Total Capacity: 120 Community Beds: 120 Sheltered Beds: 0 Pediatric Beds: 0 Private Rooms: 2 2-Bed Rooms: 59 3-Bed Rooms: 0 4-Bed Rooms: 0 | |||||||||
| AHCA Number (File Number): | 70519 | |||||||||
| AHCA Field Office: | 07 | |||||||||
| License Number: | 16420951 | |||||||||
| Current License Effective: | 12/30/2024 | |||||||||
| Current License Expires: | 12/29/2026 | |||||||||
| License Status: | LICENSED | |||||||||
Services/Characteristics
| Current Daily Rate: | 312.00 |
| Adult Day Care Services: | No |
| Continuing Care Retirement Community: | No |
| Languages Spoken: | CreoleFilipinoFrenchSign LanguageSpanish |
| Payment Forms Accepted: | CHAMPUS/TRICAREInsurance and/or HMOMedicaidMedicareVAWorkers Compensation |
| Special Programs and Services: | 24 hr Onsite RN CoverageHIV CareHospice CareJCAHO accredited Long Term Care ProgramPet TherapyRespiteTracheotomyWeight Training |
Emergency Power Plan Summary
| Onsite Alternate Power Source: | Fixed Generator |
| Emergency Power Supports: | Entire Facility |
| Plan Approval: | 6/11/2018 |
| Implementation Date: | 10/29/2019 |
| Implementation Extended Until: | 1/1/2019 |
| Cooling Method: | Air Conditioner |
| Areas Cooled: | Entire Facility |
| Areas Cooled Location: | Within Facility |
| Square Footage Cooled: | 51,792 |
| Number of People to use Cooled Space: | 180 |
Legal Actions
| Date Initiated | Case # | Case Type | Violation | Fine Amount | Date Imposed |
|---|---|---|---|---|---|
| 10/16/2019 | 2019016163 | Rule Variance/Waiver | Administrative Rule | $0.00 | 12/11/2019 |
| 5/3/2019 | 2019007028 | Rule Variance/Waiver | Administrative Rule | $0.00 | 6/13/2019 |
| 9/26/2018 | 2018014509 | Rule Variance/Waiver | Administrative Rule | $0.00 | 12/13/2018 |
| 10/13/2017 | 2017012176 | Rule Variance/Waiver | Administrative Rule | $0.00 | 11/9/2017 |
| 6/28/2010 | 2010006647 | Fine | Survey | $1,500.00 | 3/23/2011 |
| 6/28/2010 | 2010006648 | Conditional License | Survey | $0.00 | 5/6/2010 |
| 4/21/2008 | 2008006648 | Fine | Survey | $750.00 | 8/14/2008 |
| 4/21/2008 | 2008006649 | Conditional License | Survey | $0.00 | 4/8/2008 |
| 5/10/2005 | 2005003933 | Fine | Reporting | $500.00 | 7/22/2005 |
| 3/10/2004 | 2004002318 | Fine | Survey | $2,000.00 | 8/31/2004 |
| 3/10/2004 | 2004002804 | Conditional License | Survey | $0.00 | 2/25/2004 |
Important information and facility/provider definitions can be found in the Glossary.
Attn Providers: Requests for changes in data must be sent in writing to the AHCA licensing office.