Healthcare Provider Details

I. General information

NPI: 1518568294
Provider Name (Legal Business Name): OPEN SKYES FAMILY CARE HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2020
Last Update Date: 11/08/2020
Certification Date: 11/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 SW 36TH ST
WEST PARK FL
33023-6106
US

IV. Provider business mailing address

8570 STIRLING RD STE 102
HOLLYWOOD FL
33024-8204
US

V. Phone/Fax

Practice location:
  • Phone: 954-329-9796
  • Fax:
Mailing address:
  • Phone: 954-329-9796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ARYSSIA PHILLIP
Title or Position: OWNER
Credential:
Phone: 954-864-0802