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NPI Code Detail

MEDICARE: BUCKELEW PROGRAMS

MEDICARE: BUCKELEW PROGRAMS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1324500000XSubstance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1467167965
Entity Type Code : Organization
Provider Name (Legal Business Name) : BUCKELEW PROGRAMS
Provider Business Mailing Address
First Line : 201 ALAMEDA DEL PRADO STE 103
Second Line :
City : NOVATO
State : CA
Zip : 94949-6698
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 540 MIDDLE RINCON RD
Second Line :
City : SANTA ROSA
State : CA
Zip : 95409-3107
Country : US
Telephone Number : 707-909-0168
Fax Number :
Authorized Official
Title or Position : CEO
Name : JOHN CHRISTOPHER KUGHN
Credential : LMFT
Telephone Number : 415-457-6966
Provider Enumeration Date : 01/18/2023
Last Update Date : 06/05/2025

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Directions to “BUCKELEW PROGRAMS ” Practice Location

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