Provider Demographics
NPI:1558194837
Name:SKYCENTER, LLC
Entity type:Organization
Organization Name:SKYCENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTARTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SKY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMLOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-500-9658
Mailing Address - Street 1:5460 WHITE OAK AVE UNIT H203
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4595
Mailing Address - Country:US
Mailing Address - Phone:310-500-9658
Mailing Address - Fax:
Practice Address - Street 1:5311 TOPANGA CANYON BLVD STE 311
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1740
Practice Address - Country:US
Practice Address - Phone:310-500-9658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health