Provider Demographics
NPI:1023984713
Name:SKY COMFORT LIVING LLC
Entity type:Organization
Organization Name:SKY COMFORT LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DERIC FADEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUNGUE TIYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-508-1338
Mailing Address - Street 1:13624 DESSAU RD APT 11106
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-7087
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13624 DESSAU RD APT 11106
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-7087
Practice Address - Country:US
Practice Address - Phone:405-508-1338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-11
Last Update Date:2025-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities