NPIMap

Organization Active NPI

Back to Life, Incorporated

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Phoenix, AZ
National Provider Identifier
1497937767
Registry record updated Nov 29, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
BH2772 Issued in AZ
Legal business name
BACK TO LIFE, INCORPORATED
Practice address
5915 W Roanoke Ave
Phoenix, AZ 85035-1639
Phone
(623) 594-4870
Fax
(623) 444-9213
NPI assigned
Nov 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2007

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

Authorized official

Name
Mrs. Gracie Padilla Contreras
Title
Chief Executive Officer
Phone
(623) 594-4870

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X BH2772 AZ Primary

Addresses

Primary practice location

5915 W Roanoke Ave
Phoenix, AZ 85035-1639

Mailing address

PO Box 8237
Phoenix, AZ 85066-8237
Phone (623) 594-4870

Other identifiers 1

IdentifierTypeStateIssuer
143580MedicaidAZ

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.

NPI Registry JSON

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

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196294400000",
    "number": "1497937767",
    "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": "623-594-4870",
            "fax_number": "623-444-9213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5915 W ROANOKE AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850351639",
            "telephone_number": "623-594-4870",
            "fax_number": "623-444-9213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACK TO LIFE, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-28",
        "last_updated": "2007-11-29",
        "status": "A",
        "authorized_official_last_name": "CONTRERAS",
        "authorized_official_first_name": "GRACIE",
        "authorized_official_middle_name": "PADILLA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "623-594-4870",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "AZ",
            "license": "BH2772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "143580",
            "state": "AZ"
        }
    ],
    "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 Nov 29, 2007; 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.