Provider Demographics
NPI:1093473712
Name:CONCIERGE CARE OF ORANGE PARK, LLC
Entity Type:Organization
Organization Name:CONCIERGE CARE OF ORANGE PARK, LLC
Other - Org Name:CONCIERGE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
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:904-861-0196
Mailing Address - Fax:
Practice Address - Street 1:1857 WELLS RD STE 224
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2340
Practice Address - Country:US
Practice Address - Phone:904-441-6860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care