Provider Demographics
NPI:1457131195
Name:BACK TO LIFE SERVICES LLC
Entity Type:Organization
Organization Name:BACK TO LIFE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHUKWUEMEKA
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:OGWUDILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-207-0231
Mailing Address - Street 1:7205 PETERSBURG DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-2049
Mailing Address - Country:US
Mailing Address - Phone:972-207-0231
Mailing Address - Fax:
Practice Address - Street 1:7205 PETERSBURG DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-2049
Practice Address - Country:US
Practice Address - Phone:972-207-0231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)