Provider Demographics
NPI:1497139935
Name:SKYWAY HOUSE, LLC
Entity Type:Organization
Organization Name:SKYWAY HOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CARVALHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-898-8326
Mailing Address - Street 1:40 LANDING CIR STE 1
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-7901
Mailing Address - Country:US
Mailing Address - Phone:530-898-8326
Mailing Address - Fax:530-898-0239
Practice Address - Street 1:6000 COHASSET RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-8861
Practice Address - Country:US
Practice Address - Phone:530-893-3698
Practice Address - Fax:530-893-3748
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACADIA HEALTHCARE COMPANY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040006CN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility