MEDICARE: BACK TO LIFE AGENCY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1427775709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK TO LIFE AGENCY LLC

Provider Business Mailing Address
First Line	:	800 E 227TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-4421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 E 227TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-4421
Country	:	US
Telephone Number	:	718-231-1629
Fax Number	:

Authorized Official
Title or Position	:	CEO/ PRESIDENT
Name	:	EMILY GUILFUCHI
Credential	:
Telephone Number	:	929-476-6949

Provider Enumeration Date	:	10/26/2022
Last Update Date	:	10/26/2022

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Directions to “BACK TO LIFE AGENCY LLC ” Practice Location

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