MEDICARE: BUILDING OPPORTUNITIES FOR SELF-SUFFICIENCY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8133	OTHER	CA	MEDI-CAL PROVIDER NUMBER

General Provider Information

NPI Number	:	1649481060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUILDING OPPORTUNITIES FOR SELF-SUFFICIENCY

Provider Business Mailing Address
First Line	:	2065 KITTREDGE ST STE E
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94704-1404
Country	:	US
Telephone Number	:	510-649-1930
Fax Number	:	510-649-0627

Provider Business Practice Location Address
First Line	:	2116 BROADWAY
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94612-2310
Country	:	US
Telephone Number	:	510-899-4100
Fax Number	:	510-350-3322

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. BOONA CHEEMA
Credential	:
Telephone Number	:	510-649-1930

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	01/24/2011

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Directions to “BUILDING OPPORTUNITIES FOR SELF-SUFFICIENCY ” Practice Location

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