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General NPI Number Information
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NPI Number | 1053526715
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Entity Type | Organization
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Legal Business Name | BONITA HOUSE, INC.
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 12/24/2024
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Provider Practice Location Address
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Address Line | 7200 BANCROFT AVE STE 267
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City | OAKLAND
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State | CA
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Zip | 94605-2403
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Country | US
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Telephone | 510-735-0864
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Fax | 510-746-1196
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Provider Business Mailing Address
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Address Line | 1919 ADDISON ST STE 204
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City | BERKELEY
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State | CA
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Zip | 94704-1143
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Country | US
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Telephone | 510-899-7445
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Fax | 510-647-9408
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LAURA EVON WEISSBERGER
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Credential | LCSW
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Telephone | 510-593-1950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 01EE1
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License Number State | CA
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