Provider Demographics
NPI:1679970230
Name:BUCKEYE THERAPEUTICS AND MEDIATION, LLC
Entity Type:Organization
Organization Name:BUCKEYE THERAPEUTICS AND MEDIATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:EINHORN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:505-821-9973
Mailing Address - Street 1:PO BOX 26813
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6813
Mailing Address - Country:US
Mailing Address - Phone:505-821-9973
Mailing Address - Fax:
Practice Address - Street 1:3916 JUAN TABO BLVD NE STE 23
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3981
Practice Address - Country:US
Practice Address - Phone:505-821-9973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-08334104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty