Healthcare Provider Details

I. General information

NPI: 1629383633
Provider Name (Legal Business Name): BUILDING TO LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 08/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7419 BARCLAY RD
CHELTENHAM PA
19012-1302
US

IV. Provider business mailing address

PO BOX 6335
PHILADELPHIA PA
19139-6335
US

V. Phone/Fax

Practice location:
  • Phone: 215-281-8458
  • Fax:
Mailing address:
  • Phone: 215-281-8458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: WALTER E DAVIS
Title or Position: PROGRAM DIRECTOR
Credential: BS/ICCJP/ICCDP
Phone: 215-281-8458