Organization
BONITA HOUSE, INC.
Active
Parent organization
BONITA HOUSE INC
Other names
Residential Program
Organization subpart
Yes
Provider details
NPI number
Legal business name
BONITA HOUSE INC
Authorized official
LAURA EVON WEISSBERGER LCSW (EXECUTIVE DIRECTOR)
(510) 593-1950
Entity
Organization
Contact information
Practice address
1410 BONITA AVE, BERKELEY, CA 94709-1909
(510) 526-4765
(510) 526-2887
Mailing address
2640 MARTIN LUTHER KING JR WAY, BERKELEY, CA 94704-3238
(510) 899-7445
(510) 647-9408
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
81491
CA
251S00000X
Community/Behavioral Health Agency
Primary
81492
CA
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81491
—
CA
05
—
81492
—
CA
05
—
81493
—
CA
Enumeration date
05/14/2007
Last updated
12/24/2024
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