Healthcare Provider Details

I. General information

NPI: 1912570102
Provider Name (Legal Business Name): READY FOR LIFE COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 E WASHINGTON ST
PHOENIX AZ
85034-1903
US

IV. Provider business mailing address

10810 N TATUM BLVD STE 102211
PHOENIX AZ
85028-0502
US

V. Phone/Fax

Practice location:
  • Phone: 602-435-2522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. WILLIAM E LANE
Title or Position: CHARIMAN OF THE BOARD
Credential:
Phone: 602-435-2522