Provider Demographics
NPI:1093225666
Name:CONCIERGE CARE OF PALM COAST LLC
Entity Type:Organization
Organization Name:CONCIERGE CARE OF PALM COAST LLC
Other - Org Name:CONCIERGE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:RALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-534-1655
Mailing Address - Street 1:6817 SOUTHPOINT PKWY STE 1004
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8201
Mailing Address - Country:US
Mailing Address - Phone:904-534-1655
Mailing Address - Fax:
Practice Address - Street 1:14 OFFICE PARK DR STE 4
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3830
Practice Address - Country:US
Practice Address - Phone:386-337-3006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-09
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00000OtherSENIOR CARE REFFERAL AGENCY