Healthcare Provider Details

I. General information

NPI: 1023342920
Provider Name (Legal Business Name): SKY LIMITS 1, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N COCOA BLVD UNIT 102
COCOA FL
32922-7582
US

IV. Provider business mailing address

PO BOX 372029
SATELLITE BEACH FL
32937-0029
US

V. Phone/Fax

Practice location:
  • Phone: 321-632-0675
  • Fax: 321-632-0673
Mailing address:
  • Phone: 321-632-0675
  • Fax: 321-632-0673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number30211419
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number30211419
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number30211419
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. ANTWON MONTAE TRICE
Title or Position: PRESIDENT
Credential:
Phone: 843-655-5860