Provider Demographics
NPI:1326697731
Name:DAISY CONCIERGE CARE
Entity Type:Organization
Organization Name:DAISY CONCIERGE CARE
Other - Org Name:DAISY CONCIERGE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:SHANTA
Authorized Official - Middle Name:LACOLE
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-529-6473
Mailing Address - Street 1:437 S. MORRIS RD LT 1
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768
Mailing Address - Country:US
Mailing Address - Phone:229-529-6473
Mailing Address - Fax:800-890-5501
Practice Address - Street 1:437 S. MORRIS RD LT 1
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768
Practice Address - Country:US
Practice Address - Phone:229-529-6473
Practice Address - Fax:800-890-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-09
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No291U00000XLaboratoriesClinical Medical Laboratory