Provider Demographics
NPI:1114322278
Name:BUILDING OPPORTUNITIES FOR SELF-SUFFICIENCY
Entity Type:Organization
Organization Name:BUILDING OPPORTUNITIES FOR SELF-SUFFICIENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:IVY
Authorized Official - Last Name:FRAIZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-649-1930
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:510-649-1930
Mailing Address - Fax:510-649-0627
Practice Address - Street 1:711 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-1313
Practice Address - Country:US
Practice Address - Phone:510-525-4469
Practice Address - Fax:510-525-2657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management