Provider Demographics
NPI:1750863049
Name:BLUE SKY HOPE AND RECOVERY CENTER
Entity Type:Organization
Organization Name:BLUE SKY HOPE AND RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCHINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:501-416-2170
Mailing Address - Street 1:3711 ROBINWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-8374
Mailing Address - Country:US
Mailing Address - Phone:501-416-2170
Mailing Address - Fax:
Practice Address - Street 1:2615 N PRICKETT RD
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-7523
Practice Address - Country:US
Practice Address - Phone:501-416-2170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-03
Last Update Date:2018-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)