Organization
LONGEVITY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHERYL LYNN ALLEN (BILLING MANAGER)
(616) 897-2142
Entity
Organization
Contact information
Practice address
2251 E PARIS AVE SE, GRAND RAPIDS, MI 49546-2431
(616) 956-6090
(616) 956-6099
Mailing address
2251 E PARIS AVE SE, GRAND RAPIDS, MI 49546-2431
(616) 956-6090
(616) 956-6099
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101007920
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1719945
—
MI
Enumeration date
02/25/2008
Last updated
05/14/2009
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