Provider Demographics
NPI:1184476160
Name:SKYLINE UNDER 21 LLC
Entity type:Organization
Organization Name:SKYLINE UNDER 21 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-348-5510
Mailing Address - Street 1:106 ASBURY WAY
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-6382
Mailing Address - Country:US
Mailing Address - Phone:757-348-5510
Mailing Address - Fax:757-522-1954
Practice Address - Street 1:3104 CAMELOT BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-2501
Practice Address - Country:US
Practice Address - Phone:757-348-5510
Practice Address - Fax:757-522-1954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities