Healthcare Provider Details

I. General information

NPI: 1487252185
Provider Name (Legal Business Name): CONCIERGE HOME CARE OF LAKE MARY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 INTERNATIONAL PKWY STE 102
HEATHROW FL
32746-5071
US

IV. Provider business mailing address

4655 SALISBURY RD STE 110
JACKSONVILLE FL
32256-0957
US

V. Phone/Fax

Practice location:
  • Phone: 904-733-1003
  • Fax: 904-448-8855
Mailing address:
  • Phone: 904-733-1003
  • Fax: 904-448-8855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT GREGORY YOUNG
Title or Position: SECRETARY & CAO
Credential:
Phone: 904-733-1003