1467164582 NPI number — CONCIERGE CARE OF NORTH CENTRAL FL, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467164582 NPI number — CONCIERGE CARE OF NORTH CENTRAL FL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONCIERGE CARE OF NORTH CENTRAL FL, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467164582
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6817 SOUTHPOINT PKWY STE 901
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32216-8201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-534-1655
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2622 NW 43RD ST STE C4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32606-6679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-310-0006
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/20/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RALSTON
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
904-534-1655

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)