Longevity Center LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5101007920 Issued in MI

Legal business name

LONGEVITY CENTER LLC

Practice address

2251 E Paris Ave SE
Grand Rapids, MI 49546-2431

Phone

(616) 956-6090

Fax

(616) 956-6099

NPI assigned

Feb 25, 2008

Last updated

May 14, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Cheryl Lynn Allen

Title

Billing Manager

Phone

(616) 897-2142

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242259200000",
    "number": "1144499195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2251 E PARIS AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462431",
            "telephone_number": "616-956-6090",
            "fax_number": "616-956-6099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2251 E PARIS AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462431",
            "telephone_number": "616-956-6090",
            "fax_number": "616-956-6099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-25",
        "last_updated": "2009-05-14",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "616-897-2142",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101007920",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1719945",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn Long, NP-C
• Kristin Long
• Reyan Long
• Sarah Long, MA, CCC-SLP
• Molly Renee Longcore
• Deborah Longley, MD
• Molly Longman
• Shaniya Longmire
• Leticia Longoria
• Aubrey Jo Longstreet

• Family Medicine Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.