Provider Demographics
NPI:1558794578
Name:BUILDING OPPURTUNITY FOR SELF-SUFFICIENCY
Entity Type:Organization
Organization Name:BUILDING OPPURTUNITY FOR SELF-SUFFICIENCY
Other - Org Name:BOSS SERVICE TEAM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF HOUSING
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-649-8174
Mailing Address - Street 1:2116 BROADWAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612
Mailing Address - Country:US
Mailing Address - Phone:510-899-4100
Mailing Address - Fax:510-350-3322
Practice Address - Street 1:2116 BROADWAY AVENUE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612
Practice Address - Country:US
Practice Address - Phone:510-899-4100
Practice Address - Fax:510-350-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1649481060Medicare UPIN