Provider Demographics
NPI:1790162543
Name:LONGEVITY AND ME
Entity Type:Organization
Organization Name:LONGEVITY AND ME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:ADINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN-GUILLAUME
Authorized Official - Suffix:
Authorized Official - Credentials:LICNURSE/MASSAGE TH
Authorized Official - Phone:305-725-4471
Mailing Address - Street 1:15290 WILSHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2213
Mailing Address - Country:US
Mailing Address - Phone:305-725-4471
Mailing Address - Fax:
Practice Address - Street 1:15290 WILSHIRE WAY
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-2213
Practice Address - Country:US
Practice Address - Phone:305-725-4471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty