Buckelew Program - Mail

NPI 1073579926 - Community Based Residential Treatment Facility, Mental Illness - 320800000X

NPI Details
NPI 1073579926
Enumeration Date 04/20/2006
Last Updated 03/25/2015
Entity Type Healthcare Provider
Active Over 11 years ago
Authorized Information
Name CLAIRE CLAIRE
Position PROGRAM DIRECTOR
Phone (415) 457-1925
Fax (415) 457-1929
Practice Location
1401 LOS GAMOS DR
SUITE 240
SAN RAFAEL CA, 94903-1809, US
Phone (415) 457-1925
Fax (415) 457-1929
Business Location
1401 LOS GAMOS DR
SUITE 240
SAN RAFAEL CA, 94903-1809, US
Phone (415) 457-1925
Fax (415) 457-1929
Toxanomy
Taxonomy Code 320800000X
License State California
License Number 210102749
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According to our database, Buckelew Program - Mail NPI is 1073579926, taxonomy code is 320800000X and license number is 210102749, license state is located at California. Buckelew Program - Mail physically located at 1401 Los Gamos Dr, San Rafael CA, 94903-1809. NPI Number 1033115704 has the healthcare provider type.

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1073579926 NPI number is provided on an as is basis without warranty of any kind. 1073579926 is maintained by the National Plan & Provider Enumeration System. The contents of Buckelew Program - Mail are for informational purposes only.