Back to Life, Incorporated

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

BH-5346 Issued in AZ

Legal business name

BACK TO LIFE, INCORPORATED

Practice address

3301 N 63Rd Ave
Phoenix, AZ 85033-5203

Phone

(623) 249-4448

Fax

(623) 444-7829

NPI assigned

Jan 10, 2018

Organization subpart

No

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

Authorized official

Name

Ms. Gracie Gonzalez Padilla

Title

Chief Executive Officer

Phone

(602) 999-2400

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1515542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571356800000",
    "number": "1093223125",
    "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": "623-518-9552",
            "fax_number": "623-444-7829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 N 63RD AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850335203",
            "telephone_number": "623-249-4448",
            "fax_number": "623-444-7829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACK TO LIFE, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-10",
        "last_updated": "2019-10-18",
        "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": "602-999-2400",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "AZ",
            "license": "BH-5346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Emotionally Disturbed Childrens' Residential Treatment Facility in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 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.