Provider Demographics
NPI:1033455423
Name:LUNGEVITY HEALTHCARE, LLC
Entity Type:Organization
Organization Name:LUNGEVITY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEONIDAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FENELON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-383-1851
Mailing Address - Street 1:7531 FAIRWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-6500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7531 FAIRWAY BLVD
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-6500
Practice Address - Country:US
Practice Address - Phone:954-383-1851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health