Healthcare Provider Details

I. General information

NPI: 1467837021
Provider Name (Legal Business Name): SKYCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 MORGAN RD
MADISON HTS VA
24572-2527
US

IV. Provider business mailing address

193 MORGAN RD
MADISON HTS VA
24572-2527
US

V. Phone/Fax

Practice location:
  • Phone: 201-852-2309
  • Fax:
Mailing address:
  • Phone: 201-852-2309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

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