Longevity Home Healthcare, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

LONGEVITY HOME HEALTHCARE, LLC

Practice address

3450 Laurel Fort Meade Rd Ste 205
Laurel, MD 20724-2104

Phone

(240) 389-5292

NPI assigned

Jun 6, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Godson Chukwuma Ezejiofor, DHA

Title

Administrator

Phone

(240) 460-3969

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Longevity Home Health Care, LLC Doing business as

Locations

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

{
    "created_epoch": "1528243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659916800000",
    "number": "1477045276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 LAUREL FORT MEADE RD STE 205",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207242104",
            "telephone_number": "240-389-5292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 LAUREL FORT MEADE RD STE 205",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207242104",
            "telephone_number": "240-389-5292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY HOME HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-06",
        "last_updated": "2022-08-08",
        "certification_date": "2022-08-08",
        "status": "A",
        "authorized_official_last_name": "EZEJIOFOR",
        "authorized_official_first_name": "GODSON",
        "authorized_official_middle_name": "CHUKWUMA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "240-460-3969",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DHA"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100236795",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Longevity Home Health Care, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2022; 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.