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General NPI Number Information
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NPI Number | 1922334622
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Entity Type | Organization
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Legal Business Name | BUCKELEW PROGRAMS
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Dates
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Enumeration Date | 10/30/2009
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Last Update Date | 10/30/2009
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Provider Practice Location Address
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Address Line | 914 MISSION AVE
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City | SAN RAFAEL
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State | CA
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Zip | 94901-6106
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Country | US
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Telephone | 415-457-6964
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Fax |
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Provider Business Mailing Address
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Address Line | 1109 SIR FRANCIS DRAKE BLVD
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City | KENTFIELD
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State | CA
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Zip | 94904
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Country | US
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Telephone | 415-459-6965
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Fax |
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Authorized Official
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Title or Position | SITE DIRECTOR
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Name | JOHN P WHITTY
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Credential |
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Telephone | 415-459-6965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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