Provider Demographics
NPI:1174212344
Name:SKY CARE ABA, LLC
Entity type:Organization
Organization Name:SKY CARE ABA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DEQO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:LGSW
Authorized Official - Phone:952-393-0229
Mailing Address - Street 1:27 14TH AVE N APT 205
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7474
Mailing Address - Country:US
Mailing Address - Phone:952-393-0229
Mailing Address - Fax:
Practice Address - Street 1:27 14TH AVE N APT 205
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7474
Practice Address - Country:US
Practice Address - Phone:952-393-0229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-03
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty