Organization Active NPI

Bonnie Brae

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Basking Ridge, NJ
National Provider Identifier
1871768564
Registry record updated Apr 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
BONNIE BRAE
Practice address
3415 Valley Road
Basking Ridge, NJ 07920
Phone
(908) 647-0800
Fax
(908) 647-5021
NPI assigned
Apr 24, 2008
Last updated
Apr 24, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
BONNIE BRAEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 24, 2008

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

Authorized official

Name
Mr. William M. Powers
Title
Cfo
Phone
(908) 647-0800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X NJ Primary

Addresses

Primary practice location

3415 Valley Road
Basking Ridge, NJ 07920

Mailing address

3415 Valley Road
PO Box 825
Liberty Corner, NJ 07938-0825
Phone (908) 647-0800

Other identifiers 1

IdentifierTypeStateIssuer
0137588MedicaidNJ

National Provider Directory

National Provider Directory
Tax ID family
Bonnie Brae13 organizations share this tax ID, including this one
Part of
Bonnie Brae

Other organizations with this tax ID 12

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

NPI Registry JSON

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

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208995200000",
    "number": "1871768564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3415 VALLEY ROAD",
            "address_2": "PO BOX 825",
            "city": "LIBERTY CORNER",
            "state": "NJ",
            "postal_code": "079380825",
            "telephone_number": "908-647-0800",
            "fax_number": "908-647-5021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3415 VALLEY ROAD",
            "city": "BASKING RIDGE",
            "state": "NJ",
            "postal_code": "07920",
            "telephone_number": "908-647-0800",
            "fax_number": "908-647-5021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONNIE BRAE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BONNIE BRAE",
        "enumeration_date": "2008-04-24",
        "last_updated": "2008-04-24",
        "status": "A",
        "authorized_official_last_name": "POWERS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "908-647-0800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0137588",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Basking Ridge, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2008; 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.