Healthcare Provider Details

I. General information

NPI: 1699648899
Provider Name (Legal Business Name): BACKED BY GOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10983 W SHERIDAN ST
AVONDALE AZ
85392-5884
US

IV. Provider business mailing address

10983 W SHERIDAN ST
AVONDALE AZ
85392-5884
US

V. Phone/Fax

Practice location:
  • Phone: 323-841-1541
  • Fax:
Mailing address:
  • Phone: 323-841-1541
  • Fax: 323-841-1541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: RENESHA GRIFFITH
Title or Position: PRESIDENT
Credential:
Phone: 323-841-1541