Basic Information
| Provider Information | |||||||||
| NPI: | 1033517404 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONCIERGE CARE OF DAYTONA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6817 SOUTHPOINT PKWY | ||||||||
| Address2: | SUITE 1503 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322166282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048610196 | ||||||||
| FaxNumber: | 9044858253 | ||||||||
| Practice Location | |||||||||
| Address1: | 1452 N US HIGHWAY 1 | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | ORMOND BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321746638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3868681555 | ||||||||
| FaxNumber: | 9044858253 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2014 | ||||||||
| LastUpdateDate: | 12/17/2014 | ||||||||
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| AuthorizedOfficialLastName: | RALSTON | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 9045341655 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
No ID Information.