Provider Demographics
NPI:1770285637
Name:LONGEVITY LIFE PARTNERS LLC
Entity type:Organization
Organization Name:LONGEVITY LIFE PARTNERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:ITZAK
Authorized Official - Last Name:WINAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-621-7460
Mailing Address - Street 1:2339 CLUBHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5616
Mailing Address - Country:US
Mailing Address - Phone:818-621-7460
Mailing Address - Fax:
Practice Address - Street 1:2339 CLUBHOUSE DR
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5616
Practice Address - Country:US
Practice Address - Phone:818-621-7460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty