Provider Demographics
NPI:1538595434
Name:AGELESS MEN'S HEALTH HOLDINGS, LLC
Entity type:Organization
Organization Name:AGELESS MEN'S HEALTH HOLDINGS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-818-0446
Mailing Address - Street 1:111 W WASHINGTON ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-2703
Mailing Address - Country:US
Mailing Address - Phone:901-757-3643
Mailing Address - Fax:901-757-7762
Practice Address - Street 1:111 W WASHINGTON ST
Practice Address - Street 2:SUITE 901
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2703
Practice Address - Country:US
Practice Address - Phone:901-757-3643
Practice Address - Fax:901-757-7762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty