NPIMap

Organization Active NPI

Buckelew Programs

Doing business as Athena House

  • Substance Abuse Rehabilitation Facility
  • Santa Rosa, CA
National Provider Identifier
1184304776
Registry record updated Mar 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
BUCKELEW PROGRAMS
Doing business as
Athena House
Buckelew Orenda Center
Practice address
1430 Neotomas Ave
Santa Rosa, CA 95405-7575
Phone
(707) 565-7450
NPI assigned
Jul 19, 2023
Last updated
Mar 4, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
BUCKELEW PROGRAMSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 4, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Christopher Kughn, LMFTNPI 1821012279
Title
Ceo
Phone
(415) 457-6966

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

1430 Neotomas Ave
Santa Rosa, CA 95405-7575

Mailing address

201 Alameda del Prado Ste 103
Novato, CA 94949-6698
Phone (415) 457-6964

Other names 2

  • Athena House Doing business as
  • Buckelew Orenda Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Buckelew Programs13 organizations share this tax ID, including this one
Part of
Buckelew Programs

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709510400000",
    "number": "1184304776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 ALAMEDA DEL PRADO STE 103",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949496698",
            "telephone_number": "415-457-6964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 NEOTOMAS AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954057575",
            "telephone_number": "707-565-7450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUCKELEW PROGRAMS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BUCKELEW PROGRAMS",
        "enumeration_date": "2023-07-19",
        "last_updated": "2024-03-04",
        "certification_date": "2024-01-29",
        "status": "A",
        "authorized_official_last_name": "KUGHN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "415-457-6966",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Athena House",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Buckelew Orenda Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.