Provider Demographics
NPI:1659736262
Name:ANTI-AGING, INC
Entity Type:Organization
Organization Name:ANTI-AGING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CORI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:435-862-3137
Mailing Address - Street 1:10200 TRAILING DALEA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2083
Mailing Address - Country:US
Mailing Address - Phone:435-862-3137
Mailing Address - Fax:
Practice Address - Street 1:10200 TRAILING DALEA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-2083
Practice Address - Country:US
Practice Address - Phone:435-862-3137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-24
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001946261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service