Provider Demographics
NPI:1720815129
Name:PEAK STATE RECOVERY, LLC
Entity type:Organization
Organization Name:PEAK STATE RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:S
Authorized Official - Last Name:DICKIE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:501-428-6980
Mailing Address - Street 1:1055 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-8922
Mailing Address - Country:US
Mailing Address - Phone:501-428-6980
Mailing Address - Fax:
Practice Address - Street 1:22163-22295 AR-9
Practice Address - Street 2:
Practice Address - City:PARON
Practice Address - State:AR
Practice Address - Zip Code:72122
Practice Address - Country:US
Practice Address - Phone:501-428-6980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility