BACK TO LIFE INCORPORATED (NPI# 1013558311) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013558311 |
| Entity Type | Organization |
| Organization Name | BACK TO LIFE INCORPORATED |
| Practice Address |
6420 W Cocopah St Phoenix AZ 85043 |
| Mailing Address |
Po Box 8237 Phoenix AZ 85066-8237 |
| Practice Telephone | 6029992400 |
| Practice Fax Number | 6234447829 |
| Mailing Telephone | 6029992400 |
| Mailing Fax Number | 6234447829 |
| Enumeration Date | 2019-10-08 |
| Last Update Date | 2019-10-08 |
| Authorized Official Name | MS. GRACIE GONZALEZ PADILLA (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 6235189552 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932381167 | Back To Life Incorporated | Residential Treatment Facility, Emotionally Disturbed Children | 3301 N 63rd Ave, Phoenix, AZ 85033-5203 | 2007-11-29 |
| Street Address |
6420 W COCOPAH ST |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85043 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962936112 | Christine B Santa Cruz | Specialist/Technologist | 8101 W. Hammond Ln., Phoenix, AZ 85043 | 2017-04-14 |
| 1558704809 | Valley Independent Residential LLC | Community Based Residential Treatment Facility, Mental Illness | 6408 W Gross Ave, Phoenix, AZ 85043 | 2013-04-16 |
| 1275811598 | Diamond Manor Adult Care | Custodial Care Facility | 7330 W. Getty Drive, Phoenix, AZ 85043 | 2011-08-03 |
| 1821312877 | Bertha Romero | Case Manager/Care Coordinator | 7315 W Jones Ave, Phx, AZ 85043 | 2010-03-19 |
| 1477705788 | Patrick Lynn Perryman | Psychologist | 7250 W Buckeye Rd, Phoenix, AZ 85043 | 2008-10-17 |
| 1891910246 | Sammie Trotter | Technician | 5025 S. 24th Ave, Phoenix, AZ 85043 | 2007-04-13 |
| 1780719617 | German Dobson Cvs, L.L.C. | Durable Medical Equipment & Medical Supplies | 6650 W. Lower Buckeye Rd, Phoenix, AZ 85043 | 2007-02-22 |
| 1992713689 | Occupational Health Center of The Southwest Pa | Clinic/Center | 5340 West Buckeye Road, Suite 3, Phoenix, AZ 85043 | 2006-08-04 |
| 1972523710 | William A Crane Jr. | Family Medicine | 7953 W Chickasaw St, Phoenix, AZ 85043 | 2006-07-21 |
| 1578505780 | Revondolyn L Scott | Nutritionist | 8135 W Lynwood St, Phoenix, AZ 85043 | 2006-06-12 |
| Find all providers in zip 85043 | ||||
| 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 |
|---|---|---|---|---|
| 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 |
| 1619299054 | House of Hope | Residential Treatment Facility, Emotionally Disturbed Children | 5814 S 11th St, Phoenix, AZ 85040-3177 | 2010-02-26 |
| 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.