Healthcare Provider Details

I. General information

NPI: 1003764531
Provider Name (Legal Business Name): SKY HOUSE SUPPORTIVE LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 CALAVERAS AVE
DAVIS CA
95616-3024
US

IV. Provider business mailing address

2240 CALAVERAS AVE
DAVIS CA
95616-3024
US

V. Phone/Fax

Practice location:
  • Phone: 916-407-9722
  • Fax:
Mailing address:
  • Phone: 916-407-9722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN SKY
Title or Position: CEO
Credential: LCSW
Phone: 191-640-7972