Healthcare Provider Details

I. General information

NPI: 1821933805
Provider Name (Legal Business Name): SKINNER LEGACIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 BEELER DR
BEREA OH
44017-1438
US

IV. Provider business mailing address

239 BEELER DR
BEREA OH
44017-1438
US

V. Phone/Fax

Practice location:
  • Phone: 440-666-3994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMBER SKINNER
Title or Position: CEO
Credential:
Phone: 440-666-3994