Healthcare Provider Details

I. General information

NPI: 1316839129
Provider Name (Legal Business Name): SKYLINE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 THOMAS AVE APT 5
SAINT PAUL MN
55104-2641
US

IV. Provider business mailing address

1090 THOMAS AVE APT 5
SAINT PAUL MN
55104-2641
US

V. Phone/Fax

Practice location:
  • Phone: 651-440-2657
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MALACK NYOKWOYO
Title or Position: OWNER
Credential:
Phone: 651-440-2657