Healthcare Provider Details

I. General information

NPI: 1144746454
Provider Name (Legal Business Name): SKYCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 08/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3119 SPRING GLEN RD
JACKSONVILLE FL
32207-5914
US

IV. Provider business mailing address

1273 EBENEZER RD STE C
ROCK HILL SC
29732-2353
US

V. Phone/Fax

Practice location:
  • Phone: 201-852-2309
  • Fax:
Mailing address:
  • Phone: 803-587-8036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: MS. QUIANA MESHELL DIXON
Title or Position: OWNER/CEO
Credential:
Phone: 201-852-2309