# BACK TO LIFE, INC

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

## Provider details

- **NPI number:** 1982871901
- **Authorized official:** MRS. GRACIE PADILLA CONTRERAS (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (623) 594-4870

## Contact information

- **Practice address:** 12613 N 36TH LN, PHOENIX, AZ 85029-2108
- **Practice address phone:** (602) 354-4055
- **Mailing address:** PO BOX 8237, PHOENIX, AZ 85066-8237
- **Mailing address phone:** (623) 594-4870

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | BH 3093 | AZ | Yes |

## Other

- **Enumeration date:** 05/08/2008
- **Last updated:** 05/08/2008