Sky Lake Recovery Center, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

SKY LAKE RECOVERY CENTER, LLC

Practice address

586 Glorene Ave
South Lake Tahoe, CA 96150-3907

Phone

(530) 539-9026

NPI assigned

Dec 15, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Nathtan Tuddenham, CADC-CS CA

Title

Chief Operating Officer

Phone

(831) 740-4629

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1513296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663632000000",
    "number": "1487160388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 GAFFEY RD",
            "city": "WATSONVILLE",
            "state": "CA",
            "postal_code": "950769731",
            "telephone_number": "831-740-4629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "586 GLORENE AVE",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961503907",
            "telephone_number": "530-539-9026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKY LAKE RECOVERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-15",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A",
        "authorized_official_last_name": "TUDDENHAM",
        "authorized_official_first_name": "NATHTAN",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "831-740-4629",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CADC-CS CA"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Geoffrey Sieux, PHARMD
• Robert Silk, M.D.
• David Matthew Silkey, MPT, CSCS
• Erik Silverman, PT
• Ilia Garcia Sippel, DDS
• SLT Medical Group Inc
• Sheree Smail
• Faye M. Smith-Chakmakova, MD
• Amy Pittlick Smith, NP
• Mary Rhonda Sneeringer, MD

• Substance Abuse Rehabilitation Facility in South Lake Tahoe, CA
• Providers in South Lake Tahoe, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.