# BACK TO LIFE INCORPORATED

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013558311
- **Authorized official:** MS. GRACIE GONZALEZ PADILLA (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (623) 518-9552

## Contact information

- **Practice address:** 6420 W COCOPAH ST, PHOENIX, AZ 85043
- **Practice address phone:** (602) 999-2400
- **Practice address fax:** (623) 444-7829
- **Mailing address:** PO BOX 8237, PHOENIX, AZ 85066-8237
- **Mailing address phone:** (602) 999-2400
- **Mailing address fax:** (623) 444-7829

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | — | Yes |

## Other

- **Enumeration date:** 10/08/2019
- **Last updated:** 10/08/2019