Healthcare Provider Details

I. General information

NPI: 1457131195
Provider Name (Legal Business Name): BACK TO LIFE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 10/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7205 PETERSBURG DR
PLANO TX
75074-2049
US

IV. Provider business mailing address

7205 PETERSBURG DR
PLANO TX
75074-2049
US

V. Phone/Fax

Practice location:
  • Phone: 972-207-0231
  • Fax:
Mailing address:
  • Phone: 972-207-0231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: CHUKWUEMEKA GEORGE OGWUDILE
Title or Position: DIRECTOR
Credential:
Phone: 972-207-0231