MEDICARE: SKYLIGHT GARDENS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	343548	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235365271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKYLIGHT GARDENS

Provider Business Mailing Address
First Line	:	501 1ST ST N
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-4705
Country	:	US
Telephone Number	:	320-259-4584
Fax Number	:	320-259-6159

Provider Business Practice Location Address
First Line	:	501 1ST ST N
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-4705
Country	:	US
Telephone Number	:	320-259-4584
Fax Number	:	320-259-6159

Authorized Official
Title or Position	:	COMMUNITY MANAGER
Name	:	MICHELLE LYNN MACE
Credential	:
Telephone Number	:	320-259-4584

Provider Enumeration Date	:	06/04/2009
Last Update Date	:	06/04/2009

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