Basic Information
| Provider Information | |||||||||
| NPI: | 1811559735 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BONITA HOUSE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6333 TELEGRAPH AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946091359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109231099 | ||||||||
| FaxNumber: | 5109230894 | ||||||||
| Practice Location | |||||||||
| Address1: | 1909 UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108091780 | ||||||||
| FaxNumber: | 5108931642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2019 | ||||||||
| LastUpdateDate: | 06/02/2020 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | LORNA | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5109231099 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | M.ED-MBA | ||||||||
| NPICertificationDate: | 06/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.