Provider Demographics
NPI:1023342920
Name:SKY LIMITS 1, INC
Entity type:Organization
Organization Name:SKY LIMITS 1, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTWON
Authorized Official - Middle Name:MONTAE
Authorized Official - Last Name:TRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-655-5860
Mailing Address - Street 1:PO BOX 372029
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-0029
Mailing Address - Country:US
Mailing Address - Phone:321-632-0675
Mailing Address - Fax:321-632-0673
Practice Address - Street 1:950 N COCOA BLVD
Practice Address - Street 2:UNIT 102
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7582
Practice Address - Country:US
Practice Address - Phone:321-632-0675
Practice Address - Fax:321-632-0673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211419251F00000X, 251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care