Provider Demographics
NPI:1902335334
Name:LONGEVITY HOME CARE LLC
Entity Type:Organization
Organization Name:LONGEVITY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DIR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:QUACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-321-3066
Mailing Address - Street 1:2709 BECHTOL ST
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-4021
Mailing Address - Country:US
Mailing Address - Phone:469-321-3066
Mailing Address - Fax:
Practice Address - Street 1:1102 CABANA LN
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5329
Practice Address - Country:US
Practice Address - Phone:469-321-3066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health