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General NPI Number Information
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NPI Number | 1790195162
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Entity Type | Organization
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Legal Business Name | BLUE SKIES RECOVERY CENTER
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Dates
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Enumeration Date | 05/06/2014
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Last Update Date | 05/06/2014
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Provider Practice Location Address
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Address Line | 727 24TH ST SUITE 3
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City | OGDEN
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State | UT
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Zip | 84401-2581
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Country | US
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Telephone | 801-392-8900
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Fax | 801-394-5085
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Provider Business Mailing Address
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Address Line | PO BOX 762
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City | OGDEN
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State | UT
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Zip | 84402-0762
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Country | US
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Telephone | 801-392-8900
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Fax | 801-394-5085
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. PAM JEAN GRAMSE
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Credential |
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Telephone | 801-392-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 3782
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License Number State | UT
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