Provider Demographics
NPI:1134914203
Name:HEALTH & LIFESTYLES VIP LLC
Entity type:Organization
Organization Name:HEALTH & LIFESTYLES VIP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:STOCKTON
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:606-306-7706
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:KY
Mailing Address - Zip Code:42602-0237
Mailing Address - Country:US
Mailing Address - Phone:606-934-0684
Mailing Address - Fax:606-777-7560
Practice Address - Street 1:61 CONCORD SPUR ROAD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:KY
Practice Address - Zip Code:42602
Practice Address - Country:US
Practice Address - Phone:606-934-0684
Practice Address - Fax:606-777-7560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty