Basic Information
| Provider Information | |||||||||
| NPI: | 1528313228 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DUKE CITY RECOVERY TOOLBOX, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 912 1ST ST NW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871022355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052249777 | ||||||||
| FaxNumber: | 5052249779 | ||||||||
| Practice Location | |||||||||
| Address1: | 912 1ST ST NW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871022355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052249777 | ||||||||
| FaxNumber: | 5052249779 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2012 | ||||||||
| LastUpdateDate: | 06/03/2022 | ||||||||
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| AuthorizedOfficialLastName: | WIDNER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | HERMAN | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5052249777 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CADAC, A.D.C | ||||||||
| NPICertificationDate: | 06/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302R00000X | 03-219048-00-0 | NM | N | Managed Care Organizations | Health Maintenance Organization | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.