Healthcare Provider Details

I. General information

NPI: 1619113362
Provider Name (Legal Business Name): LIFE BUILDERS INTERVENTION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2008
Last Update Date: 12/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 DUBLIN CASTLE RD
GREENSBORO NC
27407-6468
US

IV. Provider business mailing address

4401 DUBLIN CASTLE RD
GREENSBORO NC
27407-6468
US

V. Phone/Fax

Practice location:
  • Phone: 336-382-2525
  • Fax: 888-862-1114
Mailing address:
  • Phone: 336-382-2525
  • Fax: 888-862-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRAUNDRA CARTER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 336-382-2525