| Bonita House, Inc. | |
|
1410 Bonita Ave Berkeley CA 94709-1909 | |
| (510) 526-4765 | |
| Not Available |
| Full Name | Bonita House, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1410 Bonita Ave, Berkeley, California |
| Authorized Official Name and Position | Laura Evon Weissberger (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 1059319505 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bonita House, Inc. 1919 Addison St Ste 204 Berkeley CA 94704-1143 Ph: (510) 899-7445 | Bonita House, Inc. 1410 Bonita Ave Berkeley CA 94709-1909 Ph: (510) 526-4765 |
| NPI Number | 1760697312 |
|---|---|
| Provider Enumeration Date | 05/14/2007 |
| Last Update Date | 08/26/2023 |
| Certification Date | 08/26/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760697312 | NPI | - | NPPES |
| 81492 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 81492 (California) | Primary |
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