Healthcare Provider Details

I. General information

NPI: 1710615182
Provider Name (Legal Business Name): IN BALANCE ADOLESCENT TRANSITIONAL LIVING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 N CAMPBELL AVE SUITE 205
TUCSON AZ
85719-8571
US

IV. Provider business mailing address

6107 E GRANT RD
TUCSON AZ
85712-5828
US

V. Phone/Fax

Practice location:
  • Phone: 207-229-6315
  • Fax:
Mailing address:
  • Phone: 520-722-9631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: SHARON REYNOLDS
Title or Position: EXEC ADMIN DIRECTOR
Credential:
Phone: 520-722-9631