Healthcare Provider Details

I. General information

NPI: 1497501019
Provider Name (Legal Business Name): SKYSHROUD HOME HEALTH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5480 COLD LAKE ST
LAS VEGAS NV
89148-7609
US

IV. Provider business mailing address

5480 COLD LAKE ST
LAS VEGAS NV
89148-7609
US

V. Phone/Fax

Practice location:
  • Phone: 702-289-9797
  • Fax:
Mailing address:
  • Phone: 702-289-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: SAINT DON NIEL BAUTISTA REYES
Title or Position: CEO
Credential: PT, ATP
Phone: 702-289-9797