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General NPI Number Information
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NPI Number | 1679970230
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Entity Type | Organization
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Legal Business Name | BUCKEYE THERAPEUTICS AND MEDIATION, LLC
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Dates
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Enumeration Date | 11/25/2014
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 3916 JUAN TABO BLVD NE STE 23
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3981
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Country | US
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Telephone | 505-821-9973
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 26813
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6813
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Country | US
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Telephone | 505-821-9973
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | JONATHAN J EINHORN
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Credential | LMSW
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Telephone | 505-821-9973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | M-08334
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License Number State | NM
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