Provider Demographics
NPI:1407067846
Name:BUILDING OPPORTUNITIES FOR SELF-SUFFICIENCY
Entity Type:Organization
Organization Name:BUILDING OPPORTUNITIES FOR SELF-SUFFICIENCY
Other - Org Name:BOSS SHELTER NETWORK MAA
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:IVY
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-649-1935
Mailing Address - Street 1:1918 UNIVERSITY AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-3263
Mailing Address - Country:US
Mailing Address - Phone:510-649-1930
Mailing Address - Fax:510-649-0627
Practice Address - Street 1:258 W A ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4850
Practice Address - Country:US
Practice Address - Phone:510-732-5956
Practice Address - Fax:510-732-5954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8134OtherMEDI-CAL PROVIDER NUMBER