MEDICARE: CONCIERGE CARE OF DAYTONA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00000	OTHER	FL	SENIOR CARE REFERRAL AGENCY

General Provider Information

NPI Number	:	1033517404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCIERGE CARE OF DAYTONA, LLC

Provider Business Mailing Address
First Line	:	6817 SOUTHPOINT PKWY STE 1004
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-8201
Country	:	US
Telephone Number	:	904-861-0196
Fax Number	:	904-485-8253

Provider Business Practice Location Address
First Line	:	555 W GRANADA BLVD STE H9
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-9432
Country	:	US
Telephone Number	:	386-868-1555
Fax Number	:	904-485-8253

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MS. NANCY RALSTON
Credential	:	RN
Telephone Number	:	904-534-1655

Provider Enumeration Date	:	12/16/2014
Last Update Date	:	10/25/2024

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