| Entity Name: | CONCIERGE HOME CARE OF ST. AUGUSTINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 11 Sep 2020 (4 years ago) |
| Last Event: | LC AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 22 Dec 2020 (4 years ago) |
| Document Number: | L20000277007 |
| FEI/EIN Number | 853371068 |
| Mail Address: | 4655 Salisbury Rd, JACKSONVILLE, FL, 32256, US |
| Address: | 100 WHETSTONE PL, ST AUGUSTINE, FL, 32086-5775, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073111787 | 2020-10-14 | 2023-12-27 | 4655 SALISBURY RD STE 110, JACKSONVILLE, FL, 322560957, US | 100 WHETSTONE PL STE 302, ST AUGUSTINE, FL, 320865775, US | |||||||||||||||||||||||||||||
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| Phone | +1 904-733-1003 |
| Fax | 9044488855 |
| Phone | +1 904-224-8025 |
Authorized person
| Name | MR. ROBERT GREGORY YOUNG |
| Role | SECRETARY |
| Phone | 9047331003 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AHCA |
| Number | 299995246 |
| State | FL |
| Issuer | CLIA |
| Number | 10D2222039 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| YOUNG ROBERT G | Agent | 4655 Salisbury Rd, JACKSONVILLE, FL, 32256 |
| Name | Role | Address |
|---|---|---|
| CONCIERGE HOME CARE OF ST. AUGUSTINE HOLDI | Member | 4655 Salisbury Rd, JACKSONVILLE, FL, 32256 |
| Name | Role | Address |
|---|---|---|
| Rucker David C | Chief Executive Officer | 4655 Salisbury Rd, JACKSONVILLE, FL, 32256 |
| Name | Role | Address |
|---|---|---|
| FISHER JEFFREY L | President | 4655 Salisbury Rd, JACKSONVILLE, FL, 32256 |
| Name | Role | Address |
|---|---|---|
| YOUNG ROBERT G | Secretary | 4655 Salisbury Rd, JACKSONVILLE, FL, 32256 |
| Name | Role | Address |
|---|---|---|
| Young Robert G | Chief Financial Officer | 4655 Salisbury Rd, JACKSONVILLE, FL, 32256 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000157912 | CONCIERGE HOME CARE | ACTIVE | 2020-12-13 | 2025-12-31 | No data | 4655 SALISBURY ROAD, SUITE 110, JACKSONVILLE, FL, 32256 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-06-30 | 100 WHETSTONE PL, STE 302, ST AUGUSTINE, FL 32086-5775 | No data |
| CHANGE OF MAILING ADDRESS | 2021-04-22 | 100 WHETSTONE PL, STE 302, ST AUGUSTINE, FL 32086-5775 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-04-22 | 4655 Salisbury Rd, Suite 110, JACKSONVILLE, FL 32256 | No data |
| LC AMENDMENT AND NAME CHANGE | 2020-12-22 | CONCIERGE HOME CARE OF ST. AUGUSTINE HOLDINGS, LLC | 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 |
| AMENDED ANNUAL REPORT | 2021-04-22 |
| ANNUAL REPORT | 2021-01-04 |
| LC Amendment and Name Change | 2020-12-22 |
| Florida Limited Liability | 2020-09-11 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
