Provider Demographics
NPI:1790471076
Name:SKYE MESA LLC
Entity Type:Organization
Organization Name:SKYE MESA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:SKYE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-303-0726
Mailing Address - Street 1:5 WARM CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:NM
Mailing Address - Zip Code:88041-9536
Mailing Address - Country:US
Mailing Address - Phone:505-303-0726
Mailing Address - Fax:
Practice Address - Street 1:5 WARM CREEK RD
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:NM
Practice Address - Zip Code:88041-9536
Practice Address - Country:US
Practice Address - Phone:505-303-0726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health