| Ageless Living Institute Llc | |
|
1670 Willow Creek Rd Ste A Prescott AZ 86301-1112 | |
| (928) 255-5191 | |
| (928) 316-9703 |
| Full Name | Ageless Living Institute Llc |
|---|---|
| Speciality | Physician Assistant |
| Location | 1670 Willow Creek Rd Ste A, Prescott, Arizona |
| Authorized Official Name and Position | Mark Joseph Kledzik (MEMBER) |
| Authorized Official Contact | 9282555191 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ageless Living Institute Llc 1670 Willow Creek Rd Ste A Prescott AZ 86301-1112 Ph: (928) 255-5191 | Ageless Living Institute Llc 1670 Willow Creek Rd Ste A Prescott AZ 86301-1112 Ph: (928) 255-5191 |
| NPI Number | 1770160269 |
|---|---|
| Provider Enumeration Date | 03/29/2021 |
| Last Update Date | 02/02/2023 |
| Medicare PECOS PAC ID | 3870962152 |
|---|---|
| Medicare Enrollment ID | O20221208000501 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770160269 | NPI | - | NPPES |
| 1437452836 | Medicaid | AZ |
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