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SKYSTAR RESIDENTIAL SERVICES NPI 1396100269


NPI Information

NPI: 1396100269
Provider Name: SKYSTAR RESIDENTIAL SERVICES
Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization
Address:
406 E DOUGLAS ST
DE SOTO, IL
ZIP 62924
Phone: (618) 867-3188
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SKYSTAR RESIDENTIAL SERVICES is a community based residential treatment facility, intellectual and/or developmental disabilities in De Soto, IL. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. SKYSTAR RESIDENTIAL SERVICES NPI is 1396100269. The provider is registered as an organization entity type.

The provider's business location address is:

406 E DOUGLAS ST
DE SOTO, IL
ZIP 62924-516
Phone: (618) 867-3188
Fax: (618) 867-3098

The provider's authorized official is Randall S Duncan .
The authorized official title is Ed and has the following contact phone number (618) 867-3188.

The enumeration date for this NPI number is 12/21/2015 and was last updated on 12/21/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1320900000XCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities099600004SILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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