Healthcare Provider Details

I. General information

NPI: 1861303760
Provider Name (Legal Business Name): SKYROCKET KIDS PPEC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7378 LAKE WORTH RD
LAKE WORTH FL
33467-2529
US

IV. Provider business mailing address

7378 LAKE WORTH RD
LAKE WORTH FL
33467-2529
US

V. Phone/Fax

Practice location:
  • Phone: 561-460-5253
  • Fax:
Mailing address:
  • Phone: 561-460-5253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State

VIII. Authorized Official

Name: JAVIER MARTIN ESCALONA
Title or Position: OWNER
Credential:
Phone: 561-460-5253