| Entity Name: | CONCIERGE HOME CARE OF PORT ORANGE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 17 Aug 2020 (4 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 13 Nov 2020 (4 years ago) |
| Document Number: | L20000238814 |
| FEI/EIN Number | 85-3061951 |
| Mail Address: | 4655 Salisbury Rd, Suite 110, JACKSONVILLE, FL 32256 |
| Address: | 851 Dunlawton Ave, Ste. 201, Port Orange, FL 32127-4234 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801494505 | 2020-10-14 | 2023-12-27 | 4655 SALISBURY RD STE 110, JACKSONVILLE, FL, 322560957, US | 851 DUNLAWTON AVE STE 201, PORT ORANGE, FL, 321274234, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 904-733-1003 |
| Fax | 9044488855 |
| Phone | +1 386-257-6601 |
| Fax | 8338840077 |
Authorized person
| Name | MR. ROBERT GREGORY YOUNG |
| Role | SECRETARY & CAO |
| Phone | 9047331003 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | CLIA WAIVER |
| Number | 10D2219901 |
| State | FL |
| Issuer | AHCA STATE LICENSE |
| Number | 299995197 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| YOUNG, ROBERT G | Agent | 4655 Salisbury Rd, Suite 110, JACKSONVILLE, FL 32256 |
| Name | Role | Address |
|---|---|---|
| CONCIERGE HOME CARE OF PORT ORANGE HOLDINGS, LLC | Member | 4655 Salisbury Rd, Suite 110 Jacksonville, FL 32256 |
| Name | Role | Address |
|---|---|---|
| Rucker, David Christoper | Chief Executive Officer | 4655 Salisbury Rd, Suite 110 JACKSONVILLE, FL 32256 |
| Name | Role | Address |
|---|---|---|
| FISHER, JEFFREY L | President | 4655 Salisbury Rd, Suite 110 JACKSONVILLE, FL 32256 |
| Name | Role | Address |
|---|---|---|
| YOUNG, ROBERT GREG | Secretary | 4655 Salisbury Rd, Suite 110 JACKSONVILLE, FL 32256 |
| Name | Role | Address |
|---|---|---|
| Young, Robert Greg | Chief Financial Officer | 4655 Salisbury Rd, Suite 110 JACKSONVILLE, FL 32256 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000149488 | CONCIERGE HOME CARE | ACTIVE | 2020-11-21 | 2025-12-31 | No data | 4655 SALISBURY ROAD, SUITE 110, JACKSONVILLE, FL, 32256 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-06-12 | 851 Dunlawton Ave, Ste. 201, Port Orange, FL 32127-4234 | No data |
| CHANGE OF MAILING ADDRESS | 2021-02-22 | 851 Dunlawton Ave, Ste. 201, Port Orange, FL 32127-4234 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-02-22 | 4655 Salisbury Rd, Suite 110, JACKSONVILLE, FL 32256 | No data |
| LC AMENDMENT | 2020-11-13 | No data | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-11-13 |
| ANNUAL REPORT | 2024-02-12 |
| ANNUAL REPORT | 2023-02-09 |
| ANNUAL REPORT | 2022-02-08 |
| ANNUAL REPORT | 2021-02-22 |
| LC Amendment | 2020-11-13 |
| Florida Limited Liability | 2020-08-17 |
Date of last update: 15 Jan 2025
Sources: Florida Department of State
