NPIMap

Organization Active NPI

Buckelew Programs

  • Mental Illness Community Based Residential Treatment Facility
  • Kentfield, CA
National Provider Identifier
1861823262
Registry record updated Mar 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
216803488 Issued in CA
Legal business name
BUCKELEW PROGRAMS
Practice address
1109 Sir Francis Drake Blvd
Kentfield, CA 94904-1418
Phone
(415) 256-9995
Fax
(415) 256-9998
NPI assigned
Dec 10, 2013
Last updated
Mar 4, 2024By the provider in NPPES
Organization subpart
No

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
Chris Kughn, LMFT
Title
Ceo
Phone
(415) 457-6964

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 216803488 CA Primary

Addresses

Primary practice location

1109 Sir Francis Drake Blvd
Kentfield, CA 94904-1418

Mailing address

201 Alameda del Prado Ste 103
Novato, CA 94949-6698
Phone (415) 302-1423

Other names 1

  • Buckelew Programs Other name

National Provider Directory

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

Other organizations with this tax ID 12

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

Locations

1109 Sir Francis Drake Blvd
Kentfield, CA 94904
Phone (415) 256-9995

1401 Los Gamos Dr
Ste 240
San Rafael, CA 94903

Practitioners & affiliated clinicians

Practitioners 34

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.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1386633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709510400000",
    "number": "1861823262",
    "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": "415-302-1423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 SIR FRANCIS DRAKE BLVD",
            "city": "KENTFIELD",
            "state": "CA",
            "postal_code": "949041418",
            "telephone_number": "415-256-9995",
            "fax_number": "415-256-9998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUCKELEW PROGRAMS",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-10",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A",
        "authorized_official_last_name": "KUGHN",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "415-457-6964",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "CA",
            "license": "216803488",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Buckelew Programs",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Buckelew Programs",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kentfield, 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.