| Longevity Center Llc | |
|
2251 E Paris Ave Se Grand Rapids MI 49546-2431 | |
| (616) 956-6090 | |
| (616) 956-6099 |
| Full Name | Longevity Center Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2251 E Paris Ave Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | Cheryl Lynn Allen (BILLING MANAGER) |
| Authorized Official Contact | 6168972142 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Longevity Center Llc 2251 E Paris Ave Se Grand Rapids MI 49546-2431 Ph: (616) 956-6090 | Longevity Center Llc 2251 E Paris Ave Se Grand Rapids MI 49546-2431 Ph: (616) 956-6090 |
| NPI Number | 1144499195 |
|---|---|
| Provider Enumeration Date | 02/25/2008 |
| Last Update Date | 05/14/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144499195 | NPI | - | NPPES |
| 1719945 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 5101007920 (Michigan) | Primary |
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