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General NPI Number Information
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NPI Number | 1033737762
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Entity Type | Organization
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Legal Business Name | RETREAT AT SKYRIDGE
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 637 COUNTY ROAD 111
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City | EUREKA SPRINGS
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State | AR
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Zip | 72631-9030
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Country | US
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Telephone | 877-419-3005
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Fax | 877-419-0358
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Provider Business Mailing Address
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Address Line | 637 COUNTY ROAD 111
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City | EUREKA SPRINGS
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State | AR
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Zip | 72631-9030
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Country | US
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Telephone | 877-419-3005
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Fax | 877-419-0358
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Authorized Official
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Title or Position | CEO
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Name | DARREN WAYNE DAVIS
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Credential | R. PH
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Telephone | 877-419-3005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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