| Entity Name: | CONCIERGE HOME CARE OF PORT ST. LUCIE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 11 Sep 2020 (4 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 21 May 2021 (4 years ago) |
| Document Number: | L20000276617 |
| FEI/EIN Number | 85-3352415 |
| Address: | 1840 SE Port Saint Lucie Blvd, SUITE 1840, Port St. Lucie, FL 34952 |
| Mail Address: | 4655 Salisbury Road Suite 110, JACKSONVILLE, FL 32256 |
| ZIP code: | 34952 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184222549 | 2020-10-16 | 2023-12-27 | 4655 SALISBURY RD STE 110, JACKSONVILLE, FL, 322560957, US | 1840 SE PORT ST LUCIE BLVD STE 1840, PORT ST LUCIE, FL, 349525545, US | |||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
| Phone | +1 904-733-1003 |
| Fax | 9044488855 |
| Phone | +1 772-777-2749 |
| Fax | 7722642900 |
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 ID |
| 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 ST. LUCIE HOLDINGS, LLC | Managing Member | 4655 Salisbury Road 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 Road Suite 110, JACKSONVILLE, FL 32256 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000002257 | CONCIERGE HOME CARE | ACTIVE | 2022-01-06 | 2027-12-31 | No data | 4655 SALISBURY ROAD, SUITE 110, JACKSONVILLE, FL, 32256 |
| G20000157914 | FIVE STAR HOME CARE | ACTIVE | 2020-12-13 | 2025-12-31 | No data | 6817 SOUTHPOINT PARKWAY STE 1502, JACKSONVILLE, FL, 32216 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-02-09 | 1840 SE Port Saint Lucie Blvd, SUITE 1840, Port St. Lucie, FL 34952 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-05-17 | 1840 SE Port Saint Lucie Blvd, SUITE 1840, Port St. Lucie, FL 34952 | No data |
| LC AMENDMENT | 2021-05-21 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-02-22 | 4655 Salisbury Rd, Suite 110, Jacksonville, FL 32256 | 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 |
| LC Amendment | 2021-05-21 |
| AMENDED ANNUAL REPORT | 2021-02-22 |
| ANNUAL REPORT | 2021-01-04 |
| Florida Limited Liability | 2020-09-11 |
Date of last update: 15 Jan 2025
Sources: Florida Department of State
