Provider Demographics
NPI:1558665059
Name:BUILDING OPPORTUNITIES FOR SELF SUFFICIENCY
Entity Type:Organization
Organization Name:BUILDING OPPORTUNITIES FOR SELF SUFFICIENCY
Other - Org Name:CASA MARIA
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:510-649-1930
Mailing Address - Fax:510-649-0627
Practice Address - Street 1:2280 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1321
Practice Address - Country:US
Practice Address - Phone:510-899-4200
Practice Address - Fax:510-350-3972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8136Medicaid
CA8133Medicaid
CA8134Medicaid