MEDICARE: ROCKIE SKYE SADC LLC

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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1295549681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKIE SKYE SADC LLC

Provider Business Mailing Address
First Line	:	PO BOX 844
Second Line	:
City	:	HARRISON
State	:	NY
Zip	:	10528-0844
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1885 E MAIN ST
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1249
Country	:	US
Telephone Number	:	646-593-2685
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MALICA SUTHERLAND
Credential	:
Telephone Number	:	646-593-2685

Provider Enumeration Date	:	02/05/2025
Last Update Date	:	02/05/2025

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Directions to “ROCKIE SKYE SADC LLC ” Practice Location

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