Bonnie Brae

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

0267091 Issued in NJ

Legal business name

BONNIE BRAE

Doing business as

Bonnie Brae

Practice address

3415 Valley Rd
Basking Ridge, NJ 07920-2655

Phone

(908) 647-4702

Fax

(908) 647-5021

NPI assigned

Mar 30, 2012

Last updated

Mar 30, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Ann Zouvelekis

Title

Cfo

Phone

(908) 647-4702

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bonnie Brae Doing business as

Tax ID family

Bonnie Brae13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

• Bonnie Brae

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Basking Ridge, NJ
  • NPI 1003081605
  NPD tax ID
• Bonnie Brae

  • Mental Illness Community Based Residential Treatment Facility
  • Baking Ridge, NJ
  • NPI 1245689686
  NPD tax ID
• Bonnie Brae

  • Psychiatric Residential Treatment Facility
  • Liberty Corner, NJ
  • NPI 1447885520
  NPD tax ID
• Bonnie Brae

  • Mental Illness Community Based Residential Treatment Facility
  • Basking Ridge, NJ
  • NPI 1497152961
  NPD tax ID
• Bonnie Brae

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Liberty Corner, NJ
  • NPI 1508220922
  NPD tax ID
• Bonnie Brae

  • Psychiatric Residential Treatment Facility
  • Liberty Corner, NJ
  • NPI 1578214631
  NPD tax ID
• Bonnie Brae

  • Children's Substance Abuse Rehabilitation Facility
  • Liberty Corner, NJ
  • NPI 1780291542
  NPD tax ID
• Bonnie Brae

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Liberty Corner, NJ
  • NPI 1831448414
  NPD tax ID
• Bonnie Brae

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Basking Ridge, NJ
  • NPI 1831522523
  NPD tax ID
• Bonnie Brae

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Basking Ridge, NJ
  • NPI 1871768564
  NPD tax ID
• Bonnie Brae

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Basking Ridge, NJ
  • NPI 1902071509
  NPD tax ID
• Bonnie Brae

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Liberty Corner, NJ
  • NPI 1912063702
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1333065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333065600000",
    "number": "1235405689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 825",
            "city": "LIBERTY CORNER",
            "state": "NJ",
            "postal_code": "079380825",
            "telephone_number": "908-647-4702",
            "fax_number": "908-647-5021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3415 VALLEY RD",
            "city": "BASKING RIDGE",
            "state": "NJ",
            "postal_code": "079202655",
            "telephone_number": "908-647-4702",
            "fax_number": "908-647-5021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONNIE BRAE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-30",
        "last_updated": "2012-03-30",
        "status": "A",
        "authorized_official_last_name": "ZOUVELEKIS",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "908-647-4702",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NJ",
            "license": "0267091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0267091",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bonnie Brae",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristin Troutman Blackledge, MD
• Jacqueline Blank, D.O.
• Peter B Blank, DO
• Michael Bohrer, M.D.
• Bonnie Brae
• Bonnie Brae
• Bonnie Brae
• Bonnie Brae
• Bonnie Brae
• Angelica Borja, PT, DPT

• Emotionally Disturbed Childrens' Residential Treatment Facility in Basking Ridge, NJ
• Providers in Basking Ridge, NJ by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.