Provider Demographics
NPI:1245619378
Name:BOSS-CTEC
Entity Type:Organization
Organization Name:BOSS-CTEC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCCRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-419-0669
Mailing Address - Street 1:2065 KITTREDGE ST
Mailing Address - Street 2:SUYITE 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 1:1600 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1506
Practice Address - Country:US
Practice Address - Phone:510-419-0669
Practice Address - Fax:510-451-4362
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUILDING OPPORTUNITIES FOR SELF-SUFFICIENCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management