BONITA HOUSE, INC. (NPI# 1396950085) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396950085 |
| Entity Type | Organization |
| Organization Name | BONITA HOUSE, INC. |
| Other Organization Name | CREATIVE WELLNESS CENTER |
| Practice Address |
1802 Fairview St Berkeley CA 94703-2414 |
| Mailing Address |
6333 Telegraph Ave Suite 102 Oakland CA 94609-1359 |
| Practice Telephone | 5109232269 |
| Mailing Telephone | 5109231099 |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2012-06-07 |
| Authorized Official Name | MR. RICK R CRISPINO (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 5109231099 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | 81351 | CA | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 81351 | 05 |
| Other Name | Type Code |
|---|---|
| Creative Wellness Center | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811559735 | Bonita House, Inc. | Community/Behavioral Health | 1909 University Ave, Berkeley, CA 94704 | 2019-07-01 |
| 1073728770 | Bonita House, Inc. | Case Management | 6333 Telegraph Ave Ste 102, Oakland, CA 94609-1359 | 2007-05-14 |
| 1902253016 | Bonita House, Inc. | Community/Behavioral Health | 7200 Bancroft Ave, Suite 267, Oakland, CA 94605-2403 | 2016-05-18 |
| 1053526715 | Bonita House, Inc. | Case Management | 1422 Harrison St, Oakland, CA 94612-3903 | 2007-05-14 |
| 1235344912 | Bonita House, Inc. | Community/Behavioral Health | 1410 Bonita Ave, Berkeley, CA 94709-1909 | 2007-05-14 |
| 1760697312 | Bonita House, Inc. | Community/Behavioral Health | 1410 Bonita Ave, Berkeley, CA 94709-1909 | 2007-05-14 |
| 1528080553 | Bonita House, Inc. | Case Management | 6333 Telegraph Ave, Suite 102, Oakland, CA 94609-1359 | 2006-07-25 |
| Street Address |
1802 FAIRVIEW ST |
| City | BERKELEY |
| State | CA |
| Zip Code | 94703-2414 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720518251 | Rhys Rutgers Conger | Counselor | 1802 Fairview St, Berkeley, CA 94703-2414 | 2017-06-18 |
| 1114456241 | Jennifer Cappelletti | Counselor | 1802 Fairview St, Berkeley, CA 94703-2414 | 2017-06-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811553621 | Brittney Jerrilena Monique Garrett | Behavioral Analyst | 1901 Stuart St, Berkeley, CA 94703 | 2019-05-16 |
| 1740762178 | Maryam Jabbari Amiri | Student in an Organized Health Care Education/Training Program | 3075 Adeline Street, Suite 120, Berkeley, CA 94703 | 2018-09-01 |
| 1619427549 | Sigal Gafni | Occupational Therapist | 1622 Parker St. Apt. 1, Berkeley, CA 94703 | 2016-10-04 |
| 1750741138 | Ane Becker | Community Health Worker | 2026 Woolsey St, Berkeley, CA 94703 | 2016-02-29 |
| 1245697135 | Sara Dinome Teel Vargas | Chiropractor | 3286 Adeline St., Suite 9, Berkeley, CA 94703 | 2016-01-22 |
| 1083081608 | Olivia Debree | Nurse Practitioner | 3075 Adeline Street, Suite 280, Lifelong Medical Care, Ashby Health Center, Berkeley, CA 94703 | 2015-08-31 |
| 1962885988 | Caro Grosvenor | Marriage & Family Therapist | 1511 Ada Street, Berkeley, CA 94703 | 2015-07-08 |
| 1619378452 | Myles Malone | Counselor | 2413 Jefferson Ave., Berkeley, CA 94703 | 2014-09-11 |
| 1013340223 | Denise Daniel | Acupuncturist | 6222 La Salle Ave Suite B, Oakland, CA 94703 | 2013-08-12 |
| 1104126200 | Iramis Kouromenos | Dental Hygienist | 1721 University Ave Apt#209, Berkeley, CA 94703 | 2010-10-25 |
| Find all providers in zip 94703 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104435023 | Shuni Inc | Community/Behavioral Health | 2120 University Ave, Berkeley, CA 94704-1026 | 2020-07-27 |
| 1811559735 | Bonita House, Inc. | Community/Behavioral Health | 1909 University Ave, Berkeley, CA 94704 | 2019-07-01 |
| 1396205068 | Supportiv | Community/Behavioral Health | 2222 Harold Way, Berkeley, CA 94704-1425 | 2019-03-20 |
| 1336628338 | Satellite Affordable Housing Associates | Community/Behavioral Health | 3240 Sacramento St, Berkeley, CA 94702-2740 | 2018-08-09 |
| 1831602457 | Options Recovery Services | Community/Behavioral Health | 3331 King St, Berkeley, CA 94703-2647 | 2017-11-06 |
| 1497268072 | Options Recovery Services | Community/Behavioral Health | 1845 Addison St, Berkeley, CA 94703-1503 | 2017-11-06 |
| 1124557046 | New Bridge Foundation, Inc. | Community/Behavioral Health | 2425 Stuart St, Berkeley, CA 94705-1115 | 2017-06-05 |
| 1205362811 | County of Alameda | Community/Behavioral Health | 2015 Virginia St Rm 102, Berkeley, CA 94709-2229 | 2017-05-03 |
| 1144687435 | Ste Consultants | Community/Behavioral Health | 2560 9th St Ste 220, Berkeley, CA 94710-2565 | 2016-01-19 |
| 1144628363 | Berkeley Addiction Treatment Services | Community/Behavioral Health | 2798 Sacramento St, Berkeley, CA 94702-2337 | 2014-12-22 |
| Find all providers in BERKELEY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.