Provider Demographics
NPI:1912952888
Name:SKY NEUROLOGICAL REHABILITATION LLC
Entity Type:Organization
Organization Name:SKY NEUROLOGICAL REHABILITATION LLC
Other - Org Name:SKY NEUROLOGICAL REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:VALIENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-571-6411
Mailing Address - Street 1:190 ADMIRAL COCHRANE DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7365
Mailing Address - Country:US
Mailing Address - Phone:410-571-6411
Mailing Address - Fax:410-571-6415
Practice Address - Street 1:190 ADMIRAL COCHRANE DR
Practice Address - Street 2:SUITE 180
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7365
Practice Address - Country:US
Practice Address - Phone:410-571-6411
Practice Address - Fax:410-571-6415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD214529261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD214533Medicare ID - Type UnspecifiedCORF
MD214529Medicare ID - Type UnspecifiedCORF