MEDICARE: SKYCARE SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor
4	251B00000X	Case Management Agency
5	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1467837021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKYCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	193 MORGAN RD
Second Line	:
City	:	MADISON HTS
State	:	VA
Zip	:	24572-2527
Country	:	US
Telephone Number	:	201-852-2309
Fax Number	:

Provider Business Practice Location Address
First Line	:	193 MORGAN RD
Second Line	:
City	:	MADISON HTS
State	:	VA
Zip	:	24572-2527
Country	:	US
Telephone Number	:	201-852-2309
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	QUIANA MESHELL DIXON
Credential	:
Telephone Number	:	201-852-2309

Provider Enumeration Date	:	07/24/2015
Last Update Date	:	07/24/2015

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