Healthcare Provider Details

I. General information

NPI: 1770285637
Provider Name (Legal Business Name): LONGEVITY LIFE PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 CLUBHOUSE DR
ROCKLIN CA
95765-5616
US

IV. Provider business mailing address

2339 CLUBHOUSE DR
ROCKLIN CA
95765-5616
US

V. Phone/Fax

Practice location:
  • Phone: 818-621-7460
  • Fax:
Mailing address:
  • Phone: 818-621-7460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: AARON ITZAK WINAKER
Title or Position: PRESIDENT
Credential:
Phone: 818-621-7460