Healthcare Provider Details

I. General information

NPI: 1821755406
Provider Name (Legal Business Name): AGELESS SKYE COMPANION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 HARRISON AVE
HARRISON NY
10528-4302
US

IV. Provider business mailing address

PO BOX 844
HARRISON NY
10528-0844
US

V. Phone/Fax

Practice location:
  • Phone: 914-315-6014
  • Fax:
Mailing address:
  • Phone: 914-315-6014
  • Fax: 888-600-0158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MALICA SUTHERLAND
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 914-689-1379