Basic Information
| Provider Information | |||||||||
| NPI: | 1619335197 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DUKE CITY RECOVERY TOOLBOX LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 912 1ST ST NW | ||||||||
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| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871022355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052249777 | ||||||||
| FaxNumber: | 5052249779 | ||||||||
| Practice Location | |||||||||
| Address1: | 127 BRYN MAWR DR SE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871062265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052654220 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2016 | ||||||||
| LastUpdateDate: | 01/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | WIDNER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5052249777 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LADAC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 32D2093550 | NM | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.