NPIMap

Organization Active NPI

Back to Life Incorporated

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Phoenix, AZ
National Provider Identifier
1013558311
Registry record updated Oct 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
BACK TO LIFE INCORPORATED
Practice address
6420 W Cocopah St
Phoenix, AZ 85043
Phone
(602) 999-2400
Fax
(623) 444-7829
NPI assigned
Oct 8, 2019
Last updated
Oct 8, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Gracie Gonzalez PadillaNPI 1700670296
Title
Chief Executive Officer
Phone
(623) 518-9552

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X Primary

Addresses

Primary practice location

6420 W Cocopah St
Phoenix, AZ 85043

Mailing address

PO Box 8237
Phoenix, AZ 85066-8237
Phone (602) 999-2400

National Provider Directory

National Provider Directory
Tax ID family
Back to Life Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1570492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570492800000",
    "number": "1013558311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8237",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850668237",
            "telephone_number": "602-999-2400",
            "fax_number": "623-444-7829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6420 W COCOPAH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85043",
            "telephone_number": "602-999-2400",
            "fax_number": "623-444-7829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACK TO LIFE INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-08",
        "last_updated": "2019-10-08",
        "status": "A",
        "authorized_official_last_name": "PADILLA",
        "authorized_official_first_name": "GRACIE",
        "authorized_official_middle_name": "GONZALEZ",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "623-518-9552",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.