Organization
BUCKELEW PROGRAMS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN P WHITTY (SITE DIRECTOR)
(415) 459-6965
Entity
Organization
Contact information
Practice address
914 MISSION AVE, SAN RAFAEL, CA 94901-6106
(415) 457-6964
Mailing address
1109 SIR FRANCIS DRAKE BLVD, KENTFIELD, CA 94904
(415) 459-6965
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/30/2009
Last updated
10/30/2009
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