| Residential Program | |
|
1410 Bonita Ave Berkeley CA 94709-1909 | |
| (510) 526-4765 | |
| (510) 526-2887 |
| Full Name | Residential Program |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1410 Bonita Ave, Berkeley, California |
| Authorized Official Name and Position | Laura Evon Weissberger (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5105931950 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Residential Program 2640 Martin Luther King Jr Way Berkeley CA 94704-3238 Ph: (510) 899-7445 | Residential Program 1410 Bonita Ave Berkeley CA 94709-1909 Ph: (510) 526-4765 |
| NPI Number | 1235344912 |
|---|---|
| Provider Enumeration Date | 05/14/2007 |
| Last Update Date | 09/12/2024 |
| Certification Date | 09/12/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235344912 | NPI | - | NPPES |
| 81491 | Medicaid | CA | |
| 81493 | Medicaid | CA | |
| 81492 | Medicaid | CA |
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