Provider Demographics
NPI:1982816047
Name:LONGEVITY CARE SERVICES INC
Entity Type:Organization
Organization Name:LONGEVITY CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AURORA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-729-3873
Mailing Address - Street 1:4445 GA HIGHWAY 40 E
Mailing Address - Street 2:SUITE 503
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-4099
Mailing Address - Country:US
Mailing Address - Phone:912-729-3873
Mailing Address - Fax:
Practice Address - Street 1:4445 GA HIGHWAY 40 E
Practice Address - Street 2:SUITE 503
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-4099
Practice Address - Country:US
Practice Address - Phone:912-729-3873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty