MEDICARE: SKY CARE ABA INDIANA 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1619769510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKY CARE ABA INDIANA LLC

Provider Business Mailing Address
First Line	:	1500 AVE OF THE STATES STE 306
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4791
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 E MARKET ST FL 7
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-3294
Country	:	US
Telephone Number	:	844-390-6265
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	MRS. SARA SCHER
Credential	:
Telephone Number	:	800-604-2273

Provider Enumeration Date	:	05/19/2025
Last Update Date	:	06/24/2025

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