Provider Demographics
NPI:1972071116
Name:CONCIERGE CARE OF PONTE VEDRA LLC
Entity Type:Organization
Organization Name:CONCIERGE CARE OF PONTE VEDRA 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:904-534-1655
Mailing Address - Fax:
Practice Address - Street 1:230 CANAL BLVD STE 4
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3745
Practice Address - Country:US
Practice Address - Phone:904-429-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
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
FL0000OtherSENIOR CARE REFERRAL AGENCY