Provider Demographics
NPI:1750962585
Name:BACK 2 LIFE HOME HEALTH
Entity type:Organization
Organization Name:BACK 2 LIFE HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERMILA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:314-276-9225
Mailing Address - Street 1:9645 LILLY JEAN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63134-4236
Mailing Address - Country:US
Mailing Address - Phone:314-276-9225
Mailing Address - Fax:
Practice Address - Street 1:9645 LILLY JEAN DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63134-4236
Practice Address - Country:US
Practice Address - Phone:314-276-9225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health