Provider Demographics
NPI:1326170408
Name:SKILLS UNLIMITED INC
Entity Type:Organization
Organization Name:SKILLS UNLIMITED INC
Other - Org Name:SKILLS UNLIMITED-ELDO
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:M
Authorized Official - Last Name:NICKELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-667-6021
Mailing Address - Street 1:114 W HUNTER ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-2327
Mailing Address - Country:US
Mailing Address - Phone:417-667-6021
Mailing Address - Fax:
Practice Address - Street 1:2410 S 601 RD
Practice Address - Street 2:
Practice Address - City:EL DORADO SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64744-8245
Practice Address - Country:US
Practice Address - Phone:417-876-5481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1970-9161251C00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO853045540Medicaid