NPIMap

Organization Active NPI

Bonita House, Inc.

  • Community/Behavioral Health Agency
  • Berkeley, CA
National Provider Identifier
1760697312
Registry record updated Aug 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
81492 Issued in CA
Legal business name
BONITA HOUSE, INC.
Practice address
1410 Bonita Ave
Berkeley, CA 94709-1909
Phone
(510) 526-4765
NPI assigned
May 14, 2007
Reactivated
May 2, 2023
Last updated
Aug 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2023

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

Authorized official

Name
Laura Evon Weissberger
Title
Executive Director
Phone
(105) 931-9505

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 81492 CA Primary

Addresses

Primary practice location

1410 Bonita Ave
Berkeley, CA 94709-1909

Mailing address

1919 Addison St Ste 204
Berkeley, CA 94704-1143
Phone (510) 899-7445

Other identifiers 1

IdentifierTypeStateIssuer
81492MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Bonita House Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

1410 Bonita Ave
Berkeley, CA 94709
Phone (510) 526-4765

NPI Registry JSON

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693008000000",
    "number": "1760697312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 ADDISON ST STE 204",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947041143",
            "telephone_number": "510-899-7445",
            "fax_number": "510-647-9408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 BONITA AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947091909",
            "telephone_number": "510-526-4765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONITA HOUSE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2023-08-26",
        "certification_date": "2023-08-26",
        "deactivation_date": "2023-03-17",
        "reactivation_date": "2023-05-02",
        "status": "A",
        "authorized_official_last_name": "WEISSBERGER",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "EVON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "105-931-9505"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": "81492",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "81492",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2023; 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.