Organization
SKYLINE PROFESSIONAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JESUS DANIEL SULLIVAN MS (CEO)
(928) 446-7146
Entity
Organization
Contact information
Practice address
3970 W 24TH ST STE 209, YUMA, AZ 85364-9263
(928) 446-7146
Mailing address
3970 W 24TH ST STE 209, YUMA, AZ 85364-9263
(928) 446-7146
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
DUI0024
AZ
251S00000X
Community/Behavioral Health Agency
DVS0017
AZ
251S00000X
Community/Behavioral Health Agency
Primary
LISAC-10172
NM
Other
Enumeration date
05/06/2014
Last updated
05/06/2014
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