BACK TO LIFE, INC (NPI# 1982871901) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982871901 |
| Entity Type | Organization |
| Organization Name | BACK TO LIFE, INC |
| Practice Address |
12613 N 36th Ln Phoenix AZ 85029-2108 |
| Mailing Address |
Po Box 8237 Phoenix AZ 85066-8237 |
| Practice Telephone | 6023544055 |
| Mailing Telephone | 6235944870 |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2008-05-08 |
| Authorized Official Name | MRS. GRACIE PADILLA CONTRERAS (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 6235944870 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | BH 3093 | AZ | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427280254 | Back To Life, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 1495 W Mohawk Ln, Phoenix, AZ 85027-3618 | 2009-08-12 |
| 1255504445 | Back To Life, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 20011 N 77th Ave, Glendale, AZ 85308-8337 | 2008-04-08 |
| Street Address |
12613 N 36TH LN |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85029-2108 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477153799 | Haydee Bermudez | Counselor | 3301 North 33rd Ave., Phoenix, AZ 85029 | 2020-10-27 |
| 1871191221 | Covenant Home Health LLC | In Home Supportive Care | 11830 N. 19th Ave, Suite 101 Pendleton, Phoenix, AZ 85029 | 2020-10-16 |
| 1508406745 | Tailored 2 U Psychiatry, Pllc | Nurse Practitioner | 4150 W Peoria Avenue, Suite 116, Phoenix, AZ 85029 | 2020-01-15 |
| 1770125403 | Desert Gem Assisted Living Facility, LLC | Custodial Care Facility | 3236 W. Eugie Avenue, Phoenix, AZ 85029 | 2019-10-15 |
| 1588128623 | Anna Debbs | Counselor | 11221 North 28th Drive, Bldg E, Phoenix, AZ 85029 | 2019-01-23 |
| 1609360007 | Melissa Lynn Denton | Specialist/Technologist | 4014 W Paradise Dr, Phoenix, AZ 85029 | 2018-06-19 |
| 1275038713 | Jamilah Amirah | Behavioral Analyst | 11024 N 28th Dr Ste 110, Phoenix, AZ 85029 | 2018-03-27 |
| 1639687056 | Empower Home Care, LLC. | Home Health | 11225 N 28th Drive, Suite D115e, Phoenix, AZ 85029 | 2018-01-19 |
| 1467975698 | Samantha June Collett | Nurse Practitioner | 3201 W Peoria Ave Ste 804, Phoenix, AZ 85029 | 2017-07-19 |
| 1073966347 | Meka Joi Green | Social Worker | 11225 M 28th Dr, Suite C210, Phoenix, AZ 85029 | 2016-07-21 |
| Find all providers in zip 85029 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013558311 | Back To Life Incorporated | Residential Treatment Facility, Emotionally Disturbed Children | 6420 W Cocopah St, Phoenix, AZ 85043 | 2019-10-08 |
| 1881100147 | Anna Marie Barrios | Residential Treatment Facility, Emotionally Disturbed Children | 18811 N 7th Dr, Phoenix, AZ 85027-5508 | 2017-12-22 |
| 1023546819 | Zion Living | Residential Treatment Facility, Emotionally Disturbed Children | 1618 E Wood St, Phoenix, AZ 85040-1360 | 2017-05-24 |
| 1326400623 | Community Network Fellowship, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 1839 N 39th St, Suite A, Phoenix, AZ 85008-3915 | 2016-03-25 |
| 1972910248 | Empower House LLC | Residential Treatment Facility, Emotionally Disturbed Children | 2413 W Fetlock Trl, Phoenix, AZ 85085-5770 | 2014-07-17 |
| 1639596927 | Eagles Nest Group Home, Dba | Residential Treatment Facility, Emotionally Disturbed Children | 1802 E Dobbins Rd, Phoenix, AZ 85042-8500 | 2014-03-25 |
| 1497032668 | Vision Group Home | Residential Treatment Facility, Emotionally Disturbed Children | 2917 W Bowker St, Phoenix, AZ 85041-3477 | 2011-11-15 |
| 1548544463 | Cdh Foundation | Residential Treatment Facility, Emotionally Disturbed Children | 4017 E La Puente Ave, Phoenix, AZ 85044-1339 | 2011-10-11 |
| 1760787527 | United Youth and Family Services | Residential Treatment Facility, Emotionally Disturbed Children | 33016 N 24th Ln, Phoenix, AZ 85085-6024 | 2011-01-25 |
| 1740500966 | Oasis Care Living, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 6434 S 17th Pl, Phoenix, AZ 85042-4554 | 2010-06-10 |
| Find all providers in PHOENIX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.