Provider Demographics
NPI:1588837033
Name:BULKLEY VENTURES
Entity type:Organization
Organization Name:BULKLEY VENTURES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF INTAKE
Authorized Official - Prefix:
Authorized Official - First Name:TAMRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-332-1350
Mailing Address - Street 1:125 BULKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-2231
Mailing Address - Country:US
Mailing Address - Phone:415-332-1350
Mailing Address - Fax:
Practice Address - Street 1:135 BULKLEY AVE
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2231
Practice Address - Country:US
Practice Address - Phone:415-332-1350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210026BP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility