Provider Demographics
NPI:1639891963
Name:SKYWARD SPECTRUM LLC
Entity Type:Organization
Organization Name:SKYWARD SPECTRUM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:REECE
Authorized Official - Middle Name:
Authorized Official - Last Name:EPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-312-3735
Mailing Address - Street 1:246 ROBERT C DANIEL JR PKWY # 1051
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-0803
Mailing Address - Country:US
Mailing Address - Phone:706-434-8188
Mailing Address - Fax:706-434-8674
Practice Address - Street 1:1429 BROOKGREEN DR
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-6029
Practice Address - Country:US
Practice Address - Phone:706-434-8188
Practice Address - Fax:706-434-8674
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABA SUCCESS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty