Provider Demographics
NPI:1174379176
Name:SKYLINE MENTAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:SKYLINE MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BUSAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:OKUSANYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-445-4693
Mailing Address - Street 1:10944 QUANTICO LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10944 QUANTICO LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7527
Practice Address - Country:US
Practice Address - Phone:763-445-4693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center