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Contact Information

LONGEVITY CLINICAL LTC ASSOCIATES OF ILLINOIS PLLC
6300 N CALIFORNIA AVE
CHICAGO, IL60659-1702
 Phone: 773-973-1900
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Primary Care

363LP2300X 50 Nurse Practitioner
 

Family Medicine

207Q00000X 08 Physician/Family Practice
 

Geriatric Medicine

207QG0300X 08 Physician/Family Practice
 

Gerontology

363LG0600X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for LONGEVITY CLINICAL LTC ASSOCIATES OF ILLINOIS PLLC

NPI Number 1407422447
LBN Legal business name LONGEVITY CLINICAL LTC ASSOCIATES OF ILLINOIS PLLC
Authorized official DIANE VINCUR - (CLINICAL SUPPORT TALENT SPECIALIST)
Entity Organization
Organization subpart 1 No
Enumeration date 06/01/2021
Last updated 06/01/2021 - About 5 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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