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Organization

BACK TO LIFE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
AMBERLY WIESE OT (OWNER)
(402) 201-7852
Entity
Organization

Contact information

Practice address
305 E 1ST ST, MALVERN, IA 51551-8008
(402) 201-7852
Mailing address
PO BOX 178, MALVERN, IA 51551-0178
(402) 201-7852

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
261QR0400X
Rehabilitation Clinic/Center
Primary

Other

Enumeration date
09/21/2019
Last updated
09/21/2019
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