Provider Demographics
NPI:1770354805
Name:TOTAL CARE LONGEVITY CENTER, LLC
Entity type:Organization
Organization Name:TOTAL CARE LONGEVITY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-466-4357
Mailing Address - Street 1:213 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4342
Mailing Address - Country:US
Mailing Address - Phone:305-466-4357
Mailing Address - Fax:
Practice Address - Street 1:213 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4342
Practice Address - Country:US
Practice Address - Phone:305-466-4357
Practice Address - Fax:305-466-4358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty