Healthcare Provider Details

I. General information

NPI: 1306322896
Provider Name (Legal Business Name): BUILDING BRIDGES FOSTER FAMILY AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9302 PITTSBURGH AVE STE 210-220
RANCHO CUCAMONGA CA
91730-5563
US

IV. Provider business mailing address

2890 INLAND EMPIRE BLVD STE 100
ONTARIO CA
91764-4649
US

V. Phone/Fax

Practice location:
  • Phone: 909-233-7265
  • Fax: 626-200-1875
Mailing address:
  • Phone: 909-233-7265
  • Fax: 626-200-1875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT D MATHIAS
Title or Position: EXECUTIVE DIRECTOR
Credential: JD
Phone: 626-290-6357