Provider Demographics
NPI:1780948885
Name:DUKE CITY RECOVERY TOOLBOX LLC
Entity type:Organization
Organization Name:DUKE CITY RECOVERY TOOLBOX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HERMAN
Authorized Official - Last Name:WIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:CADAC, ADC
Authorized Official - Phone:505-224-9777
Mailing Address - Street 1:912 1ST ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2355
Mailing Address - Country:US
Mailing Address - Phone:505-224-9777
Mailing Address - Fax:505-224-9779
Practice Address - Street 1:912 1ST ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2355
Practice Address - Country:US
Practice Address - Phone:505-224-9777
Practice Address - Fax:505-224-9779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X, 261Q00000X, 261QM2800X
NM01333671251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone