Provider Demographics
NPI:1215504816
Name:AGELESS MEN'S HEALTH HOLDINGS, INC
Entity type:Organization
Organization Name:AGELESS MEN'S HEALTH HOLDINGS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-818-0446
Mailing Address - Street 1:1680 W REUNION AVE UNIT 5A
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4617
Mailing Address - Country:US
Mailing Address - Phone:801-878-7411
Mailing Address - Fax:
Practice Address - Street 1:1680 W REUNION AVE UNIT 5A
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4617
Practice Address - Country:US
Practice Address - Phone:801-878-7411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care