1033517404 NPI number — CONCIERGE CARE OF DAYTONA, LLC

Table of content: (NPI 1033517404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033517404 NPI number — CONCIERGE CARE OF DAYTONA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONCIERGE CARE OF DAYTONA, 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:
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:
1033517404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2024
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 1004
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:
904-861-0196
Provider Business Mailing Address Fax Number:
904-485-8253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 W GRANADA BLVD STE H9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORMOND BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32174-9432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-868-1555
Provider Business Practice Location Address Fax Number:
904-485-8253
Provider Enumeration Date:
12/16/2014

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)

  • Identifier: 00000 . This is a "SENIOR CARE REFERRAL AGENCY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com