Organization
TO THE MOON AND BACK PERSONAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE DAINE RODRIGUEZ (OWNER)
(915) 667-7320
Entity
Organization
Contact information
Practice address
7318 GILLETT ST, CANUTILLO, TX 79835-6421
(915) 667-7320
Mailing address
PO BOX 793, CANUTILLO, TX 79835-0793
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
05/23/2017
Last updated
05/23/2017
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