Organization
BACK TO LIFE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GRACIE PADILLA CONTRERAS (CHIEF EXECUTIVE OFFICER)
(623) 594-4870
Entity
Organization
Contact information
Practice address
20011 N 77TH AVE, GLENDALE, AZ 85308-8337
(623) 271-7843
Mailing address
PO BOX 8237, PHOENIX, AZ 85066-8237
(623) 594-4870
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
BH-3045
AZ
Other
Enumeration date
04/08/2008
Last updated
04/08/2008
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