Healthcare Provider Details

I. General information

NPI: 1548649429
Provider Name (Legal Business Name): SKYCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2015
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 EBENEZER RD
ROCK HILL SC
29732-2338
US

IV. Provider business mailing address

3144 STREAMHAVEN DR
FORT MILL SC
29707-7688
US

V. Phone/Fax

Practice location:
  • Phone: 803-587-8036
  • Fax:
Mailing address:
  • Phone: 201-852-2309
  • Fax: 803-462-5794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. QUIANA MESHELL DIXON
Title or Position: OWNER
Credential:
Phone: 201-852-2309