Provider Demographics
NPI:1679316855
Name:HEALTH & LONGEVITY INSTITUTE LLC
Entity type:Organization
Organization Name:HEALTH & LONGEVITY INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISATOU
Authorized Official - Middle Name:JOOF
Authorized Official - Last Name:JAWARA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:682-888-8471
Mailing Address - Street 1:7724 BLACK WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4628
Mailing Address - Country:US
Mailing Address - Phone:682-888-8471
Mailing Address - Fax:682-203-4126
Practice Address - Street 1:7460 WARREN PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4169
Practice Address - Country:US
Practice Address - Phone:682-888-8471
Practice Address - Fax:682-203-4126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251J00000XAgenciesNursing Care