Provider Demographics
NPI:1104642941
Name:LONGLIFE HEALTH CENTER LLC
Entity type:Organization
Organization Name:LONGLIFE HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:203-284-8661
Mailing Address - Street 1:850 N. MAIN ST. EXT.
Mailing Address - Street 2:BLDG 2, STE 3C
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2400
Mailing Address - Country:US
Mailing Address - Phone:203-284-8661
Mailing Address - Fax:203-284-1050
Practice Address - Street 1:850 N. MAIN ST. EXT.
Practice Address - Street 2:BLDG 2, STE 3C
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2400
Practice Address - Country:US
Practice Address - Phone:203-284-8661
Practice Address - Fax:203-284-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty