Basic Information
| Provider Information | |||||||||
| NPI: | 1588902621 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CONCIERGE CARE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CONCIERGE CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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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: | 6817 SOUTHPOINT PKWY | ||||||||
| Address2: | SUITE 1503 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322166282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048610196 | ||||||||
| FaxNumber: | 9044858253 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2013 | ||||||||
| LastUpdateDate: | 12/18/2014 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RALSTON | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9048610196 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | RN, BSN, GCM | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 30211656 | FL | Y | Agencies | Home Health |
No ID Information.