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General NPI Number Information
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NPI Number | 1356827281
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Entity Type | Organization
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Legal Business Name | SKY LIMITS 75 INC
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Dates
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Enumeration Date | 07/13/2018
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Last Update Date | 07/13/2018
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Provider Practice Location Address
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Address Line | 950 N COCOA BLVD STE 102
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City | COCOA
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State | FL
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Zip | 32922-7582
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Country | US
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Telephone | 184-365-5586
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Fax | 321-632-0673
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Provider Business Mailing Address
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Address Line | 950 N COCOA BLVD STE 102
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City | COCOA
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State | FL
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Zip | 32922-7582
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Country | US
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Telephone | 184-365-5586
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Fax | 321-632-0673
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTWON MONTAE TRICE
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Credential | SPECIALIST
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Telephone | 843-655-5860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 30211419
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 30211419
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License Number State | FL
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