Organization
LONGEVITY HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD NIMENE KOFA JR. (ADMINISTRATOR)
(404) 921-4511
Entity
Organization
Contact information
Practice address
906 RIVER ROCK DR # 30188, WOODSTOCK, GA 30188-5337
(404) 921-4511
Mailing address
906 RIVER ROCK DR # 30188, WOODSTOCK, GA 30188-5337
(404) 921-4511
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
06/23/2025
Last updated
06/23/2025
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