Provider Demographics
NPI:1194477026
Name:LEAN AGING WELLNESS LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:LEAN AGING WELLNESS LIMITED LIABILITY COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSEK
Authorized Official - Suffix:JR
Authorized Official - Credentials:NSCA-CPT, CTNC, CMT
Authorized Official - Phone:661-753-7708
Mailing Address - Street 1:2309 DALLIN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-5792
Mailing Address - Country:US
Mailing Address - Phone:661-753-7708
Mailing Address - Fax:661-418-5916
Practice Address - Street 1:2309 DALLIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-5792
Practice Address - Country:US
Practice Address - Phone:661-524-6160
Practice Address - Fax:661-418-5916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation