Provider Demographics
NPI:1033737762
Name:RETREAT AT SKYRIDGE
Entity Type:Organization
Organization Name:RETREAT AT SKYRIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:877-419-3005
Mailing Address - Street 1:637 COUNTY ROAD 111
Mailing Address - Street 2:
Mailing Address - City:EUREKA SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72631-9030
Mailing Address - Country:US
Mailing Address - Phone:877-419-3005
Mailing Address - Fax:877-419-0358
Practice Address - Street 1:637 COUNTY ROAD 111
Practice Address - Street 2:
Practice Address - City:EUREKA SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72631-9030
Practice Address - Country:US
Practice Address - Phone:877-419-3005
Practice Address - Fax:877-419-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility