Healthcare Provider Details

I. General information

NPI: 1952822488
Provider Name (Legal Business Name): AGELESS MEN'S HEALTH HOLDINGS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 W 800 N
OREM UT
84057-3626
US

IV. Provider business mailing address

960 W 800 N
OREM UT
84057-3626
US

V. Phone/Fax

Practice location:
  • Phone: 801-878-7411
  • Fax: 801-878-4077
Mailing address:
  • Phone: 801-878-7411
  • Fax: 801-878-4077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA WILKINSON
Title or Position: BUSINESS OPERATIONS DIRECTOR
Credential:
Phone: 702-818-0446