Back to Eden Community Clinic LLC

NPI #1912584616 in Coppell, Texas

Provider Information

NPI Number: 1912584616
Entity Type: Organization
Organization Name: Back to Eden Community Clinic LLC
Subpart: Yes (part of a larger organization)
Parent Organization: BACK TO EDEN
Primary Specialty: Clinical Medical Laboratory
Enumeration Date: Mar 27, 2021
Last Updated: May 11, 2021

Practice Location

Address: 720 DAVINCI CT
City: Coppell
State: Texas
ZIP Code: 75019-2205
Phone: (708) 224-7163

Authorized Official

Name: TUNYESSE M MURPHY
Title: OWNER
Phone: (708) 224-7163

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinical Medical Laboratory	291U00000X	Primary

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