MEDICARE: SKYPOINT RECOVERY VIRGINIA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1407693492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKYPOINT RECOVERY VIRGINIA LLC

Provider Business Mailing Address
First Line	:	3751 NINE MILE RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-4830
Country	:	US
Telephone Number	:	614-266-2289
Fax Number	:

Provider Business Practice Location Address
First Line	:	3751 NINE MILE RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-4830
Country	:	US
Telephone Number	:	614-266-2289
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	CODY COOK
Credential	:
Telephone Number	:	614-266-2289

Provider Enumeration Date	:	07/09/2024
Last Update Date	:	07/09/2024

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