Organization
BACK TO LIFE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GRACIE PADILLA CONTRERAS (C.E.O.)
(623) 518-9552
Entity
Organization
Contact information
Practice address
1495 W MOHAWK LN, PHOENIX, AZ 85027-3618
(623) 242-9671
(623) 217-2628
Mailing address
PO BOX 8237, PHOENIX, AZ 85066-8237
(623) 518-9552
(623) 444-7829
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
BH-3427
AZ
Other
Enumeration date
08/12/2009
Last updated
08/12/2009
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