Provider Demographics
NPI:1497966840
Name:BUILDING OPPORTUNITIES FOR SELF-SUFFICIENCY
Entity Type:Organization
Organization Name:BUILDING OPPORTUNITIES FOR SELF-SUFFICIENCY
Other - Org Name:HARRISON HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BOONA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEEMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-649-1930
Mailing Address - Street 1:2065 KITTREDGE ST STE E
Mailing Address - Street 2:
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:510-525-8841
Practice Address - Fax:510-525-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8136OtherMEDI-CAL PROVIDER NUMBER