NPIMap

Organization Active NPI

Buckelew Programs

  • Mental Illness Community Based Residential Treatment Facility
  • San Rafael, CA
National Provider Identifier
1922334622
Registry record updated Oct 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
BUCKELEW PROGRAMS
Practice address
914 Mission Ave
San Rafael, CA 94901-6106
Phone
(415) 457-6964
NPI assigned
Oct 30, 2009
Last updated
Oct 30, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2009

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

Authorized official

Name
John P WhittyNPI 1891833604
Title
Site Director
Phone
(415) 459-6965

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

914 Mission Ave
San Rafael, CA 94901-6106

Mailing address

1109 Sir Francis Drake Blvd
Kentfield, CA 94904
Phone (415) 459-6965

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1256860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256860800000",
    "number": "1922334622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 SIR FRANCIS DRAKE BLVD",
            "city": "KENTFIELD",
            "state": "CA",
            "postal_code": "94904",
            "telephone_number": "415-459-6965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 MISSION AVE",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949016106",
            "telephone_number": "415-457-6964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUCKELEW PROGRAMS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-30",
        "last_updated": "2009-10-30",
        "status": "A",
        "authorized_official_last_name": "WHITTY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "SITE DIRECTOR",
        "authorized_official_telephone_number": "415-459-6965"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Rafael, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2009; 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.