Provider Demographics
NPI:1467158121
Name:LONGEVITY CARE LLC
Entity Type:Organization
Organization Name:LONGEVITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SIKANDER
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAJWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-616-1276
Mailing Address - Street 1:219 CLARKSON EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2173
Mailing Address - Country:US
Mailing Address - Phone:314-741-3800
Mailing Address - Fax:314-741-3801
Practice Address - Street 1:221 CLARKSON EXECUTIVE PARK
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2173
Practice Address - Country:US
Practice Address - Phone:314-741-3800
Practice Address - Fax:314-741-3801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-03
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty