Provider Demographics
NPI:1629383633
Name:BUILDING TO LIFE
Entity Type:Organization
Organization Name:BUILDING TO LIFE
Other - Org Name:WALTER DAVIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:BS/ICCJP/ICCDP
Authorized Official - Phone:215-281-8458
Mailing Address - Street 1:PO BOX 6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-6335
Mailing Address - Country:US
Mailing Address - Phone:215-281-8458
Mailing Address - Fax:
Practice Address - Street 1:7419 BARCLAY RD
Practice Address - Street 2:
Practice Address - City:CHELTENHAM
Practice Address - State:PA
Practice Address - Zip Code:19012-1302
Practice Address - Country:US
Practice Address - Phone:215-281-8458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALTER DAVIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251K00000XAgenciesPublic Health or Welfare