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NPI Code Detail

MEDICARE: BUILDING BRIDGES FOSTER FAMILY AGENCY

MEDICARE: BUILDING BRIDGES FOSTER FAMILY AGENCY
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1336809466
Entity Type Code : Organization
Provider Name (Legal Business Name) : BUILDING BRIDGES FOSTER FAMILY AGENCY
Provider Business Mailing Address
First Line : 2890 INLAND EMPIRE BLVD STE 100
Second Line :
City : ONTARIO
State : CA
Zip : 91764-4649
Country : US
Telephone Number : 909-233-7265
Fax Number :
Provider Business Practice Location Address
First Line : 2890 INLAND EMPIRE BLVD STE 100
Second Line :
City : ONTARIO
State : CA
Zip : 91764-4649
Country : US
Telephone Number : 909-233-7265
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. ROBERT DAVID MATHIAS
Credential :
Telephone Number : 909-233-7265
Provider Enumeration Date : 12/30/2021
Last Update Date : 01/04/2022

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Directions to “BUILDING BRIDGES FOSTER FAMILY AGENCY ” Practice Location

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