Provider Demographics
NPI:1104178508
Name:BOSS
Entity Type:Organization
Organization Name:BOSS
Other - Org Name:CASA MARIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TEAM LEADER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:510-899-4207
Mailing Address - Street 1:2280 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1321
Mailing Address - Country:US
Mailing Address - Phone:510-899-4200
Mailing Address - Fax:
Practice Address - Street 1:2280 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1321
Practice Address - Country:US
Practice Address - Phone:510-899-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASA MARIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness