Longevity Health Park

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

LONGEVITY HEALTH PARK

Practice address

110 N Washington St Ste 115
Rockville, MD 20850-2223

Phone

(301) 291-5828

NPI assigned

Aug 10, 2023

Organization subpart

No

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

Authorized official

Name

Kristina Lovelace-Bailey

Title

Managing Partner

Phone

(917) 805-8922

Specialties & licenses 1

Addresses

Other names 1

• Longevity Health Infusions/inControl Doing business as

Locations

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

{
    "created_epoch": "1691625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691625600000",
    "number": "1184307704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 N WASHINGTON ST STE 115",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208502223",
            "telephone_number": "301-291-5828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 N WASHINGTON ST STE 115",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208502223",
            "telephone_number": "301-291-5828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY HEALTH PARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-10",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A",
        "authorized_official_last_name": "LOVELACE-BAILEY",
        "authorized_official_first_name": "KRISTINA",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "917-805-8922"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Longevity Health Infusions/inControl",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kelly Ann Long, COTA
• Regina J Long, CRNP-C, DNP
• Shaunasiarojeah Long
• Zion Long
• Terra Longerbeam
• Longlive Home Care MD
• Natalie Longmire
• Sharonica Longmire
• Angely Lopez Almera
• Bianca Lopez Campos

• Clinic/Center in Rockville, MD
• Providers in Rockville, MD by specialty
• Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2023; 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.