Provider Demographics
NPI:1790195162
Name:BLUE SKIES RECOVERY CENTER
Entity Type:Organization
Organization Name:BLUE SKIES RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GRAMSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-392-8900
Mailing Address - Street 1:PO BOX 762
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84402-0762
Mailing Address - Country:US
Mailing Address - Phone:801-392-8900
Mailing Address - Fax:801-394-5085
Practice Address - Street 1:727 24TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-2581
Practice Address - Country:US
Practice Address - Phone:801-392-8900
Practice Address - Fax:801-394-5085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3782261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder