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Organization
LIBERTY I, LLC
Active
Organization
LIBERTY I, LLC
Active
Other names
Concierge Home Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT G YOUNG (SECRETARY & CAO)
(904) 733-1003
Entity
Organization
Contact information
Practice address
5810 W CYPRESS ST STE 5810-A, TAMPA, FL 33607-1780
(813) 636-5017
(813) 282-1166
Mailing address
4655 SALISBURY RD STE 110, JACKSONVILLE, FL 32256-0957
(904) 733-1003
(904) 448-8855
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D1011161
CLIA WAIVER ID
FL
05
—
111117900
—
FL
01
—
299991756
AHCA STATE LICENSE
FL
01
—
299992257
AHCA STATE LICENSE
FL
01
—
299992984
AHCA STATE LICENSE
FL
Enumeration date
05/16/2006
Last updated
08/24/2026
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