Provider Demographics
NPI:1114663259
Name:SKYWAY BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:SKYWAY BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALBEGO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:224-970-1022
Mailing Address - Street 1:4709 GOLF RD FL 7
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1231
Mailing Address - Country:US
Mailing Address - Phone:224-970-1022
Mailing Address - Fax:630-919-0373
Practice Address - Street 1:4709 GOLF RD FL 7
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1231
Practice Address - Country:US
Practice Address - Phone:224-970-1022
Practice Address - Fax:630-919-0373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty