Organization Name: | AGELESS MEN'S HEALTH HOLDINGS, LLC |
NPI Number: | 1568833911 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MELISSA C MCCLELLAN (VP OF BUSINESS OPERATIONS) |
Mailing Address: | 491 West Bourne Circle Suite 2 Farmington |
State: | UT US |
Postal Code: | 84025 |
Phone Number: | 8018787411 |
Fax Number: | |
NPI Enumeration Date: | 10/12/2015 |
NPI Last Update Date: | 10/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |