Provider Demographics
NPI:1346875499
Name:CONCIERGE CARE OF ST. AUGUSTINE LLC
Entity type:Organization
Organization Name:CONCIERGE CARE OF ST. AUGUSTINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:3505 US 1 S STE 4
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-6584
Practice Address - Country:US
Practice Address - Phone:904-534-1655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00000OtherSENIOR CARE REFERRAL SERVICES