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General NPI Number Information
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NPI Number | 1184449738
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Entity Type | Organization
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Legal Business Name | RED SKY WELLNESS, LLC
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 2525 HARBOR BLVD STE 208
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5342
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Country | US
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Telephone | 804-814-7715
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Fax |
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Provider Business Mailing Address
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Address Line | 3311 NW 15TH LN
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City | CAPE CORAL
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State | FL
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Zip | 33993-9208
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Country | US
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Telephone | 804-814-7715
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Fax |
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Authorized Official
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Title or Position | MGRM
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Name | ALYSSA C COATES
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Credential | LCSW
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Telephone | 804-814-7715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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