Provider Demographics
NPI:1528313228
Name:DUKE CITY RECOVERY TOOLBOX LLC
Entity type:Organization
Organization Name:DUKE CITY RECOVERY TOOLBOX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HARTSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
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?:Yes
Parent Organization LBN:DUKE CITY RECOVERY TOOLBOX LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-18
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X, 251S00000X
NM03-219048-00-0302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM14226405Medicaid