Provider Demographics
NPI:1710615182
Name:IN BALANCE ADOLESCENT TRANSITIONAL LIVING, INC
Entity Type:Organization
Organization Name:IN BALANCE ADOLESCENT TRANSITIONAL LIVING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC ADMIN DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-722-9631
Mailing Address - Street 1:6107 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-5828
Mailing Address - Country:US
Mailing Address - Phone:520-722-9631
Mailing Address - Fax:
Practice Address - Street 1:2601 N CAMPBELL AVE SUITE 205
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-8571
Practice Address - Country:US
Practice Address - Phone:207-229-6315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility