Longevity Lives LLC

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

Legal business name

LONGEVITY LIVES LLC

Practice address

106 Breeze Hill LN
Palm Coast, FL 32137-3609

Phone

(702) 325-2119

Fax

(786) 401-6041

NPI assigned

May 29, 2023

Organization subpart

No

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

Authorized official

Name

Mr. Jeremy E Lynch

Title

Manager

Phone

(786) 401-6722

Specialties & licenses 1

Addresses

Other names 1

• Livdynamic Doing business as

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

{
    "created_epoch": "1685318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685318400000",
    "number": "1457044307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 BREEZE HILL LN",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321373609",
            "telephone_number": "702-325-2119",
            "fax_number": "786-401-6041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 BREEZE HILL LN",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321373609",
            "telephone_number": "702-325-2119",
            "fax_number": "786-401-6041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY LIVES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-29",
        "last_updated": "2023-05-29",
        "certification_date": "2023-05-27",
        "status": "A",
        "authorized_official_last_name": "LYNCH",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "786-401-6722",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Livdynamic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Health Maintenance Organization in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Health Maintenance Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 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.