Organization
LONGEVITY CLINICAL LTC ASSOCIATES OF ILLINOIS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE VINCUR (CLINICAL SUPPORT TALENT SPECIALIST)
(561) 815-2427
Entity
Organization
Contact information
Practice address
6300 N CALIFORNIA AVE, CHICAGO, IL 60659-1702
(773) 973-1900
Mailing address
11770 US HIGHWAY 1 STE 102E, PALM BEACH GARDENS, FL 33408-3052
(561) 444-0788
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/01/2021
Last updated
06/01/2021
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