Provider Demographics
NPI:1003077066
Name:CONCENTRIC HOMECARE, LLC
Entity Type:Organization
Organization Name:CONCENTRIC HOMECARE, LLC
Other - Org Name:CONCIERGE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAO & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-733-1003
Mailing Address - Street 1:4655 SALISBURY RD STE 110
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0957
Mailing Address - Country:US
Mailing Address - Phone:904-733-1003
Mailing Address - Fax:
Practice Address - Street 1:6003 HONORE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-5717
Practice Address - Country:US
Practice Address - Phone:941-342-9400
Practice Address - Fax:941-342-9403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993199251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111118300Medicaid
FL299993199OtherACHA STATE LICENSE NUMBER
FL10D1084217OtherCLIA