MEDICARE: SKY HOME SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	311ZA0620X	Adult Care Home Facility
3	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
4	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1700649597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKY HOME SERVICES

Provider Business Mailing Address
First Line	:	36545 N TAKOTA TRL
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85140-1349
Country	:	US
Telephone Number	:	801-472-0383
Fax Number	:

Provider Business Practice Location Address
First Line	:	8304 S 5150 W
Second Line	:
City	:	WEST JORDAN
State	:	UT
Zip	:	84081-2707
Country	:	US
Telephone Number	:	801-472-0383
Fax Number	:

Authorized Official
Title or Position	:	OWNER / DIRECTOR
Name	:	PAUL TONGA LANGI
Credential	:
Telephone Number	:	801-472-0383

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	02/18/2025

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