Provider Demographics
NPI:1770783193
Name:BUCKELEW PROGRAMS
Entity type:Organization
Organization Name:BUCKELEW PROGRAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOUSE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FIELDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-653-4180
Mailing Address - Street 1:1044 45TH ST
Mailing Address - Street 2:#B
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-3392
Mailing Address - Country:US
Mailing Address - Phone:510-653-4180
Mailing Address - Fax:
Practice Address - Street 1:914 MISSION AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-6106
Practice Address - Country:US
Practice Address - Phone:415-457-6964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization