=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225676455
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONCIERGE CARE OF FLORIDA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2019
-----------------------------------------------------
Last Update Date | 12/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3800 HILLCREST DR APT 1001
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33021-7939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-235-5443
-----------------------------------------------------
Fax | 407-698-5751
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3800 HILLCREST DR APT 1001
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33021-7939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-235-5443
-----------------------------------------------------
Fax | 407-698-5751
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANGELA MARINA GLASKIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-235-5443
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------