Healthcare Provider Details

I. General information

NPI: 1295670875
Provider Name (Legal Business Name): SKYBRIDGE HARMONY HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5848 S HASSETT
MESA AZ
85212-5494
US

IV. Provider business mailing address

2993 S JEFFRY ST
GILBERT AZ
85295-0047
US

V. Phone/Fax

Practice location:
  • Phone: 480-207-1652
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TUMACHA AGHENEZA
Title or Position: ADMINISTRATOR
Credential:
Phone: 857-237-1713