SKYSTAR RESIDENTIAL SERVICES (NPI# 1396100269) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396100269 |
| Entity Type | Organization |
| Organization Name | SKYSTAR RESIDENTIAL SERVICES |
| Practice Address |
406 E Douglas St De Soto IL 62924-1516 |
| Mailing Address |
406 East Douglas Desoto IL 62924 |
| Practice Telephone | 6188673188 |
| Practice Fax Number | 6188673098 |
| Mailing Telephone | 6188673188 |
| Mailing Fax Number | 6188673098 |
| Enumeration Date | 2015-12-21 |
| Last Update Date | 2015-12-21 |
| Authorized Official Name | MR. RANDALL S DUNCAN (ED) |
| Authorized Official Telephone | 6188673188 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 099600004S | IL | Residential Treatment Facilities |
| Street Address |
406 E DOUGLAS ST |
| City | DE SOTO |
| State | IL |
| Zip Code | 62924-1516 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750947586 | Kaitlyn Maloney | Physical Medicine & Rehabilitation | 125 Jan Ln Apt 2, De Soto, IL 62924-0045 | 2019-05-16 |
| 1700904216 | Desoto Cons School District 86 | Clinic/Center | 311 Hurst Rd, De Soto, IL 62924-1228 | 2007-03-26 |
| 1225200850 | Desoto Ccsd 86 | Clinic/Center | 311 Hurst Rd, De Soto, IL 62924-1228 | 2008-03-24 |
| 1184829996 | Thomas W. Kupferer, D.o. | Clinic/Center | 407 S Chestnut St, De Soto, IL 62924-1400 | 2007-06-20 |
| 1700495819 | Meghan Jo Shackleton | Nurse Practitioner | 204 N Reed Station Rd, De Soto, IL 62924-1612 | 2020-07-24 |
| 1871844415 | Pam Collins | Developmental Therapist | 1371 Leo Ln, De Soto, IL 62924-2220 | 2012-09-22 |
| 1366681397 | Louisette C. Plath | Psychologist | 151 Vaughn Rd, De Soto, IL 62924-3445 | 2009-02-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700495819 | Meghan Jo Shackleton | Nurse Practitioner | 204 N Reed Station Rd, De Soto, IL 62924-1612 | 2020-07-24 |
| 1558986000 | Christy Lynn Pashia | Counselor | 116 N 2nd St # B, De Soto, MO 63020-1701 | 2020-06-10 |
| 1356963060 | Joshua Lee Lahr | Physician Assistant | 33345 W 87th Ter, De Soto, KS 66018-7952 | 2020-05-15 |
| 1912557844 | Gabriela Marie Garza | Physician Assistant | 10160 Waverly Rd, De Soto, KS 66018-7996 | 2019-09-12 |
| 1700435385 | Patsy Maness | Technician | 5100 Knorpp Road, De Soto, MO 63020 | 2019-09-06 |
| 1184272668 | Savanah Santonge | Technician | 608 Perry St, De Soto, MO 63020-1136 | 2019-08-28 |
| 1982250494 | Laura J Peek | Pathology | 8960 Commerce Dr Bldg 6, De Soto, KS 66018-8433 | 2019-08-12 |
| 1528610946 | Korinne Elizabeth Sackett | Pharmacist | 2020 Rock Rd, De Soto, MO 63020-1052 | 2019-07-15 |
| 1326608985 | Rachel Meyer | Speech-Language Pathologist | 650 Vineland School Rd, De Soto, MO 63020-2561 | 2019-06-17 |
| 1043877004 | Reilly Schultz | Case Management | 31505 W 85th St, De Soto, KS 66018-7804 | 2019-05-24 |
| Find all providers in DE SOTO | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518329390 | Sunnyhill Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3343 Armbruster Rd, De Soto, MO 63020-4506 | 2016-03-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275131419 | Foatex Health Cilacare | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 823 163rd St, Calumet City, IL 60409-5915 | 2020-10-10 |
| 1053949404 | A Great Place To Stay LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 35580 N Knowles Rd, Lake Villa, IL 60046-9026 | 2020-03-31 |
| 1255966602 | Infinicare LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1939 Waukegan Rd Ste 300, Glenview, IL 60025-1758 | 2020-03-05 |
| 1023643772 | Supporting Community Independence | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1 Polo Grounds Ct, Bethalto, IL 62010-2623 | 2020-03-03 |
| 1770116287 | Universal Homes LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 12101 S La Salle St, Chicago, IL 60628-6618 | 2020-02-13 |
| 1760014625 | Tomeka R Morgan | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 11543 S Ashland Ave, Chicago, IL 60643-5001 | 2020-02-10 |
| 1487292660 | Shalom Home Health Ltd | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8147 Seminole Ct, Orland Park, IL 60462-4919 | 2019-12-18 |
| 1447894613 | Compassionate Living Home Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2625 Butterfield Rd Ste 314e, Oak Brook, IL 60523-1234 | 2019-10-31 |
| 1417599945 | Miracle Comprehensive Serivces | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4440 Lincoln Hwy Ste 205, Matteson, IL 60443-3803 | 2019-10-16 |
| 1609435072 | Bliss Haven, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1304 Durham St, Johnston City, IL 62951-2043 | 2019-06-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.