| Longevity Accountable Care, Pa | |
|
26505 Powers Ave Dearborn Heights MI 48125-1327 | |
| (313) 291-6200 | |
| Not Available |
| Full Name | Longevity Accountable Care, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 26505 Powers Ave, Dearborn Heights, Michigan |
| Authorized Official Name and Position | Diane Vincur (PRACTICE MANAGER) |
| Authorized Official Contact | 5618152427 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Longevity Accountable Care, Pa 11780 Us Highway 1 Ste N107 Palm Beach Gardens FL 33408-3007 Ph: (561) 815-2427 | Longevity Accountable Care, Pa 26505 Powers Ave Dearborn Heights MI 48125-1327 Ph: (313) 291-6200 |
| NPI Number | 1396584447 |
|---|---|
| Provider Enumeration Date | 05/20/2024 |
| Last Update Date | 05/20/2024 |
| Medicare PECOS PAC ID | 0840734034 |
|---|---|
| Medicare Enrollment ID | O20240628001324 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396584447 | NPI | - | NPPES |
| Provider Name | Nakesha Nacole Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689070633 PECOS PAC ID: 4183926751 Enrollment ID: I20160113002922 |
| Provider Name | Lawrence Holloway |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376920819 PECOS PAC ID: 8224300637 Enrollment ID: I20170821000291 |
| Provider Name | Jamie Nicole Lemke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790270213 PECOS PAC ID: 4082964168 Enrollment ID: I20180911002859 |
| Provider Name | Kali Mcleod |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639656721 PECOS PAC ID: 7315299856 Enrollment ID: I20181010002002 |
| Provider Name | Cassandra Freeman Hadley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790264075 PECOS PAC ID: 5193069169 Enrollment ID: I20181201000270 |
| Provider Name | Waseem Ghannam |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1306080510 PECOS PAC ID: 5092971085 Enrollment ID: I20200116002812 |
| Provider Name | Ashley Olson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477186104 PECOS PAC ID: 1355731217 Enrollment ID: I20211208000962 |
| Provider Name | Lindsay Strattard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346715117 PECOS PAC ID: 5294079190 Enrollment ID: I20220808002225 |
| Provider Name | Jamie Nkechiyere Anumba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851027320 PECOS PAC ID: 3577948678 Enrollment ID: I20220909001216 |
| Provider Name | Krystal Goudreau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609301829 PECOS PAC ID: 6901346816 Enrollment ID: I20240906000299 |
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