Healthcare Provider Details

I. General information

NPI: 1588902621
Provider Name (Legal Business Name): CONCIERGE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2013
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 SOUTHPOINT PKWY STE 1003
JACKSONVILLE FL
32216-6294
US

IV. Provider business mailing address

6817 SOUTHPOINT PKWY STE 1004
JACKSONVILLE FL
32216-8201
US

V. Phone/Fax

Practice location:
  • Phone: 904-861-0196
  • Fax: 904-485-8253
Mailing address:
  • Phone: 904-861-0196
  • Fax: 904-485-8253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. NANCY RALSTON
Title or Position: ADMINISTRATOR
Credential: RN, BSN, GCM
Phone: 904-861-0196