Provider Demographics
NPI:1679230809
Name:LIFE BUILDERS INCORPORATED
Entity Type:Organization
Organization Name:LIFE BUILDERS INCORPORATED
Other - Org Name:LIFE BUILDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TEVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VERRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-282-5295
Mailing Address - Street 1:10808 FOOTHILL BLVD # 160-154
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3889
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 E GUASTI RD STE 100
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-8661
Practice Address - Country:US
Practice Address - Phone:626-469-1158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty