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General NPI Number Information
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NPI Number | 1386992022
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Entity Type | Organization
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Legal Business Name | SKYWAY HOUSE
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 40 LANDING CIRCLE SUITE #1
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City | CHICO
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State | CA
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Zip | 95973
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Country | US
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Telephone | 530-898-8326
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Fax |
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Provider Business Mailing Address
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Address Line | 40 LANDING CIRCLE SUITE #1
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City | CHICO
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State | CA
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Zip | 95973
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Country | US
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Telephone | 530-898-8326
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MR. JOE A LODGE
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Credential |
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Telephone | 530-354-2609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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