Provider Demographics
NPI:1114208907
Name:BUILDING OPPORTUNITIES FOR SELF SUFFICIENCY
Entity Type:Organization
Organization Name:BUILDING OPPORTUNITIES FOR SELF SUFFICIENCY
Other - Org Name:PACHECO COURTS
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BARRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-649-8174
Mailing Address - Street 1:2065 KITTREDGE ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1404
Mailing Address - Country:US
Mailing Address - Phone:510-649-0627
Mailing Address - Fax:
Practice Address - Street 1:730 #8 BARTLETT AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544
Practice Address - Country:US
Practice Address - Phone:510-786-2129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8134Medicaid
CA8133Medicaid
CA8136Medicaid