Basic Information
| Provider Information | |||||||||
| NPI: | 1003077066 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CONCENTRIC HOMECARE, LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | CONCIERGE HOME CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
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| OtherCredential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 6003 HONORE AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342385717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413429400 | ||||||||
| FaxNumber: | 9413429403 | ||||||||
| Practice Location | |||||||||
| Address1: | 6003 HONORE AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342385717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413429400 | ||||||||
| FaxNumber: | 9413429403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2008 | ||||||||
| LastUpdateDate: | 04/11/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | YOUNG | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | GREGORY | ||||||||
| AuthorizedOfficialTitleorPosition: | CAO & SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 9047331003 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 299993199 | FL | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 009379900 | 05 | FL | MEDICAID | 299993199 | 01 | FL | ACHA STATE LICENSE NUMBER | OTHER |