# BACK TO LIFE, INCORPORATED

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

## Provider details

- **NPI number:** 1497937767
- **Authorized official:** MRS. GRACIE PADILLA CONTRERAS (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (623) 594-4870

## Contact information

- **Practice address:** 5915 W ROANOKE AVE, PHOENIX, AZ 85035-1639
- **Practice address phone:** (623) 594-4870
- **Practice address fax:** (623) 444-9213
- **Mailing address:** PO BOX 8237, PHOENIX, AZ 85066-8237
- **Mailing address phone:** (623) 594-4870
- **Mailing address fax:** (623) 444-9213

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | BH2772 | AZ | Yes |

## Other

- **Enumeration date:** 11/28/2007
- **Last updated:** 11/29/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 143580 | — | AZ |