Healthcare Provider Details

I. General information

NPI: 1831010438
Provider Name (Legal Business Name): SKYLINE JA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6529 E FIDDLENECK WAY
SAN TAN VALLEY AZ
85143-0641
US

IV. Provider business mailing address

6529 E FIDDLENECK WAY
SAN TAN VALLEY AZ
85143-0641
US

V. Phone/Fax

Practice location:
  • Phone: 480-255-9643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JOYCE ADU
Title or Position: ADMINISTRATOR/MANAGER
Credential:
Phone: 480-255-9643