Organization
SKYSTAR RESIDENTIAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDALL S DUNCAN (ED)
(618) 867-3188
Entity
Organization
Contact information
Practice address
406 E DOUGLAS ST, DE SOTO, IL 62924-1516
(618) 867-3188
(618) 867-3098
Mailing address
406 EAST DOUGLAS, DESOTO, IL 62924
(618) 867-3188
(618) 867-3098
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
099600004S
IL
Other
Enumeration date
12/21/2015
Last updated
12/21/2015
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