Healthcare Provider Details

I. General information

NPI: 1578818845
Provider Name (Legal Business Name): LONGEVITY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 CENTRE ST STE 200
NEWTON MA
02459-2400
US

IV. Provider business mailing address

1320 CENTRE ST STE 200
NEWTON MA
02459-2400
US

V. Phone/Fax

Practice location:
  • Phone: 617-916-1060
  • Fax: 617-323-0680
Mailing address:
  • Phone: 617-916-1060
  • Fax: 617-916-2682

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 Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: LUDMILA COSTIV
Title or Position: OWNER
Credential:
Phone: 617-916-1060