Healthcare Provider Details

I. General information

NPI: 1184449738
Provider Name (Legal Business Name): RED SKY WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 NW 15TH LN
CAPE CORAL FL
33993-9208
US

IV. Provider business mailing address

3311 NW 15TH LN
CAPE CORAL FL
33993-9208
US

V. Phone/Fax

Practice location:
  • Phone: 239-480-8648
  • Fax:
Mailing address:
  • Phone: 239-480-8648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA C COATES
Title or Position: MGRM
Credential: LCSW
Phone: 804-814-7715