Provider Demographics
NPI:1568974921
Name:LIFE BACK, LLC.
Entity Type:Organization
Organization Name:LIFE BACK, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:I
Authorized Official - Last Name:CAVALIERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-376-9410
Mailing Address - Street 1:8018 OLD COUNTY ROAD 54
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653
Mailing Address - Country:US
Mailing Address - Phone:727-376-9410
Mailing Address - Fax:727-376-4160
Practice Address - Street 1:8018 OLD COUNTY ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653
Practice Address - Country:US
Practice Address - Phone:727-376-9410
Practice Address - Fax:727-376-4160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies