Provider Demographics
NPI:1144746454
Name:SKYCARE SERVICES
Entity Type:Organization
Organization Name:SKYCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:QUIANA
Authorized Official - Middle Name:MESHELL
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-852-2309
Mailing Address - Street 1:1273 EBENEZER RD STE C
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2353
Mailing Address - Country:US
Mailing Address - Phone:803-587-8036
Mailing Address - Fax:
Practice Address - Street 1:3119 SPRING GLEN RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-5914
Practice Address - Country:US
Practice Address - Phone:201-852-2309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health