Organization
SKYLINE UNDER 21 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTIAN NICOLE LEON (EXECUTIVE DIRECTOR)
(757) 348-5510
Entity
Organization
Contact information
Practice address
3104 CAMELOT BLVD, CHESAPEAKE, VA 23323-2501
(757) 348-5510
(757) 522-1954
Mailing address
106 ASBURY WAY, SMITHFIELD, VA 23430-6382
(757) 348-5510
(757) 522-1954
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/03/2024
Last updated
04/03/2024
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