MEDICARE: READY FOR LIFE COMMUNITY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1912570102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	READY FOR LIFE COMMUNITY SERVICES

Provider Business Mailing Address
First Line	:	10810 N TATUM BLVD STE 102211
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-0502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 E WASHINGTON ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-1903
Country	:	US
Telephone Number	:	602-435-2522
Fax Number	:

Authorized Official
Title or Position	:	CHARIMAN OF THE BOARD
Name	:	MR. WILLIAM E LANE
Credential	:
Telephone Number	:	602-435-2522

Provider Enumeration Date	:	07/23/2021
Last Update Date	:	08/17/2021

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Directions to “READY FOR LIFE COMMUNITY SERVICES ” Practice Location

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