10D2220708 CLIA NUMBER - CONCIERGE HOME CARE OF LAKE CITY LLC

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Laboratory Demographics

CLIA Number: 10D2220708

Facility Name: CONCIERGE HOME CARE OF LAKE CITY LLC

Facility Address:
1140 SW BASCOM NORRIS DR SUITE 101
LAKE CITY, FL
ZIP 32025
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Facility Phone Number: 386 626-0020

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1629670310

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name	Field Value
CLIA Number	10D2220708
LAB Type	Home Health Agency
Facility Name	CONCIERGE HOME CARE OF LAKE CITY LLC
Street	1140 SW BASCOM NORRIS DR SUITE 101
City	LAKE CITY
State	FL
ZIP	32025
Phone	386 626-0020
CertificateType	4
CertificateEffectiveDate	4/14/2023
CertificateExpirationDate	4/13/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024