Provider Demographics
NPI:1891446399
Name:SKILLE THERAPEUTIC AND CHILD DEVELOPMENT CENTER LLC
Entity Type:Organization
Organization Name:SKILLE THERAPEUTIC AND CHILD DEVELOPMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CFO
Authorized Official - Prefix:
Authorized Official - First Name:LAURO
Authorized Official - Middle Name:HERNANDEZ
Authorized Official - Last Name:REYES
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN, CLS
Authorized Official - Phone:845-300-2785
Mailing Address - Street 1:60 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-4724
Mailing Address - Country:US
Mailing Address - Phone:845-300-2785
Mailing Address - Fax:
Practice Address - Street 1:60 LEE AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-4724
Practice Address - Country:US
Practice Address - Phone:845-300-2785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-16
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation MedicineGroup - Multi-Specialty