Healthcare Provider Details

I. General information

NPI: 1467167965
Provider Name (Legal Business Name): BUCKELEW PROGRAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 MIDDLE RINCON RD
SANTA ROSA CA
95409-3107
US

IV. Provider business mailing address

201 ALAMEDA DEL PRADO STE 103
NOVATO CA
94949-6698
US

V. Phone/Fax

Practice location:
  • Phone: 707-909-0168
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JOHN CHRISTOPHER KUGHN
Title or Position: CEO
Credential: LMFT
Phone: 415-457-6966