Provider Demographics
NPI:1871096396
Name:SKYLINE 21 LLC
Entity type:Organization
Organization Name:SKYLINE 21 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-690-0790
Mailing Address - Street 1:1490 OTTERBOURNE CIR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2947
Mailing Address - Country:US
Mailing Address - Phone:757-348-5510
Mailing Address - Fax:
Practice Address - Street 1:1490 OTTERBOURNE CIR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2947
Practice Address - Country:US
Practice Address - Phone:757-348-5510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-11
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
VA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care