Provider Demographics
NPI:1194463000
Name:SKYCREST PLACE LLC
Entity Type:Organization
Organization Name:SKYCREST PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-254-1196
Mailing Address - Street 1:106 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-3708
Mailing Address - Country:US
Mailing Address - Phone:727-254-1196
Mailing Address - Fax:
Practice Address - Street 1:1960 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3016
Practice Address - Country:US
Practice Address - Phone:727-254-1196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-22
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility