Provider Demographics
NPI:1497403158
Name:BUILDING BLOCKS FOR CHANGE LLC
Entity Type:Organization
Organization Name:BUILDING BLOCKS FOR CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-355-2695
Mailing Address - Street 1:3104 E CAMELBACK RD # 242
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4502
Mailing Address - Country:US
Mailing Address - Phone:702-355-2695
Mailing Address - Fax:
Practice Address - Street 1:2332 GALIANO ST FL 2
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5402
Practice Address - Country:US
Practice Address - Phone:702-355-2695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health