Provider Demographics
NPI:1831448414
Name:BONNIE BRAE
Entity type:Organization
Organization Name:BONNIE BRAE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH,MPA
Authorized Official - Phone:908-542-2732
Mailing Address - Street 1:3415 VALLEY ROAD
Mailing Address - Street 2:BONNIE BRAE
Mailing Address - City:LIBERTY CORNER
Mailing Address - State:NJ
Mailing Address - Zip Code:07938
Mailing Address - Country:US
Mailing Address - Phone:908-542-2732
Mailing Address - Fax:908-604-8869
Practice Address - Street 1:3415 VALLEY ROAD
Practice Address - Street 2:BONNIE BRAE
Practice Address - City:LIBERTY CORNER
Practice Address - State:NJ
Practice Address - Zip Code:07938
Practice Address - Country:US
Practice Address - Phone:908-542-2732
Practice Address - Fax:908-604-8869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children