Provider Demographics
NPI:1295095859
Name:LONGEVITY CARE, L.L.C.
Entity type:Organization
Organization Name:LONGEVITY CARE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKOUSSEVA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:781-248-8074
Mailing Address - Street 1:139 E FOXBORO ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2522
Mailing Address - Country:US
Mailing Address - Phone:781-248-8074
Mailing Address - Fax:617-323-0680
Practice Address - Street 1:139 E FOXBORO ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-2522
Practice Address - Country:US
Practice Address - Phone:781-248-8074
Practice Address - Fax:617-323-0680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care