Skystar Residential Services

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

099600004S Issued in IL

Legal business name

SKYSTAR RESIDENTIAL SERVICES

Practice address

406 E Douglas St
De Soto, IL 62924-1516

Phone

(618) 867-3188

Fax

(618) 867-3098

NPI assigned

Dec 21, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Randall S Duncan

Title

Ed

Phone

(618) 867-3188

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1450656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450656000000",
    "number": "1396100269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 EAST DOUGLAS",
            "city": "DESOTO",
            "state": "IL",
            "postal_code": "62924",
            "telephone_number": "618-867-3188",
            "fax_number": "618-867-3098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 E DOUGLAS ST",
            "city": "DE SOTO",
            "state": "IL",
            "postal_code": "629241516",
            "telephone_number": "618-867-3188",
            "fax_number": "618-867-3098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKYSTAR RESIDENTIAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-21",
        "last_updated": "2015-12-21",
        "status": "A",
        "authorized_official_last_name": "DUNCAN",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ED",
        "authorized_official_telephone_number": "618-867-3188",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IL",
            "license": "099600004S",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Piper Kandt
• Kendra Knaga
• Jennifer Leigh Lippold
• Kaitlyn Maloney, MS. ED., ATC, LAT
• Louisette C. Plath, PH.D.
• Thomas W. Kupferer, D.O.

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in De Soto, IL
• Providers in De Soto, IL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.