Provider Demographics
NPI:1023547841
Name:CONCIERGE CARE OF TAMPA, LLC
Entity Type:Organization
Organization Name:CONCIERGE CARE OF TAMPA, LLC
Other - Org Name:CONCIERGE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-249-2273
Mailing Address - Street 1:6817 SOUTHPOINT PKWY STE 1502
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6298
Mailing Address - Country:US
Mailing Address - Phone:904-333-9820
Mailing Address - Fax:
Practice Address - Street 1:6601 MEMORIAL HWY STE 307
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4501
Practice Address - Country:US
Practice Address - Phone:813-249-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care