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General NPI Number Information
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NPI Number | 1033493200
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Entity Type | Organization
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Legal Business Name | SKYE IS THE LIMIT RESIDENTIAL SERVICES
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 9916 REYMET CT
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23237-2375
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Country | US
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Telephone | 804-271-0825
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Fax |
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Provider Business Mailing Address
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Address Line | 9916 REYMET CT
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23237-2375
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Country | US
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Telephone | 804-271-0825
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANTYWONE WILSON
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Credential |
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Telephone | 443-591-1166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 1781
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License Number State | VA
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