Provider Demographics
NPI:1164680401
Name:LONGEVITY HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:LONGEVITY HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / DON
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ MOLLINEDA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-821-0076
Mailing Address - Street 1:15327 NW 60TH AVE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2429
Mailing Address - Country:US
Mailing Address - Phone:305-821-0076
Mailing Address - Fax:305-821-0087
Practice Address - Street 1:15327 NW 60TH AVE
Practice Address - Street 2:SUITE 235
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2429
Practice Address - Country:US
Practice Address - Phone:305-821-0076
Practice Address - Fax:305-821-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299993125OtherHOME HEALTH AGENCY LICENSE