Provider Demographics
NPI:1942730692
Name:CONCIERGE CARE OF FORT MYERS, LLC
Entity Type:Organization
Organization Name:CONCIERGE CARE OF FORT MYERS, LLC
Other - Org Name:CONCIERGE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
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:904-333-9820
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 1:12253 NEW BRITTANY BOULEVARD
Practice Address - Street 2:SUITE 32
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907
Practice Address - Country:US
Practice Address - Phone:239-689-3090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care