Healthcare Provider Details

I. General information

NPI: 1346875499
Provider Name (Legal Business Name): CONCIERGE CARE OF ST. AUGUSTINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 US 1 S STE 4
ST AUGUSTINE FL
32086-6584
US

IV. Provider business mailing address

6817 SOUTHPOINT PKWY STE 1004
JACKSONVILLE FL
32216-8201
US

V. Phone/Fax

Practice location:
  • Phone: 904-534-1655
  • Fax:
Mailing address:
  • Phone: 904-534-1655
  • Fax:

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: NANCY RALSTON
Title or Position: MANAGING PARTNER
Credential:
Phone: 904-534-1655