Provider Demographics
NPI:1033517404
Name:CONCIERGE CARE OF DAYTONA, LLC
Entity type:Organization
Organization Name:CONCIERGE CARE OF DAYTONA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:RALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
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:904-485-8253
Practice Address - Street 1:555 W GRANADA BLVD STE H9
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-9432
Practice Address - Country:US
Practice Address - Phone:386-868-1555
Practice Address - Fax:904-485-8253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00000OtherSENIOR CARE REFERRAL AGENCY