Provider Demographics
NPI:1003032517
Name:SKYWAY HOUSE, INC.
Entity Type:Organization
Organization Name:SKYWAY HOUSE, INC.
Other - Org Name:SKYWAY HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:DEICHLER, SUDCC II, CSC
Authorized Official - Suffix:
Authorized Official - Credentials:SUDCC II, CSC
Authorized Official - Phone:530-898-9424
Mailing Address - Street 1:392 CONNORS CT STE C
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1175
Mailing Address - Country:US
Mailing Address - Phone:530-898-8326
Mailing Address - Fax:530-898-0239
Practice Address - Street 1:392 CONNORS CT STE C
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1175
Practice Address - Country:US
Practice Address - Phone:530-898-8326
Practice Address - Fax:530-898-0239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040006CN324500000X
CA040006GN324500000X
CA040006LN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility