NPIMap

Organization Active NPI

Bonita House, Inc.

Doing business as Berkeley Wellness Center

  • Community/Behavioral Health Agency
  • Berkeley, CA
National Provider Identifier
1811559735
Registry record updated Dec 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
BONITA HOUSE, INC.
Doing business as
Berkeley Wellness Center
Practice address
1909 University Ave
Berkeley, CA 94704
Phone
(510) 809-1780
Fax
(510) 893-1642
NPI assigned
Jul 1, 2019
Reactivated
May 2, 2023
Last updated
Dec 24, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
BONITA HOUSE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 24, 2024

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

Authorized official

Name
Laura Evon Weissberger, LCSWNPI 1184027229
Title
Executive Director
Phone
(661) 993-9053

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

1909 University Ave
Berkeley, CA 94704

Mailing address

1919 Addison St Ste 204
Berkeley, CA 94704-1143
Phone (510) 889-7445

Other names 1

  • Berkeley Wellness Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110110000671 CA Part B Supplier - Clinic/Group Practice 1153510953 Receives reassigned benefits from 8 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Berkeley, CA; Oakland, CA

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Bonita House Inc

Locations

1909 University Ave
Berkeley, CA 94704
Phone (510) 809-3004

1422 Harrison St
Oakland, CA 94612
Phone (510) 550-8770

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1561939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734998400000",
    "number": "1811559735",
    "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": "510-889-7445",
            "fax_number": "510-647-9408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1909 UNIVERSITY AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "94704",
            "telephone_number": "510-809-1780",
            "fax_number": "510-893-1642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONITA HOUSE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BONITA HOUSE INC",
        "enumeration_date": "2019-07-01",
        "last_updated": "2024-12-24",
        "certification_date": "2024-12-24",
        "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": "661-993-9053",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Berkeley Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.