NPIMap

Organization Active NPI

Skyfall Residential Homes

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Toledo, OH
National Provider Identifier
1780259663
Registry record updated May 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
SKYFALL RESIDENTIAL HOMES
Practice address
636 Waverly Ave
Toledo, OH 43607-3836
Phone
(419) 214-9302
NPI assigned
May 24, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2021

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

Authorized official

Name
Anthonyesha FaganNPI 1831514371
Title
Owner
Phone
(419) 214-9302

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

636 Waverly Ave
Toledo, OH 43607-3836

Mailing address

636 Waverly Ave
Toledo, OH 43607-3836

National Provider Directory

National Provider Directory
Tax ID family
Skyfall Residential Homes2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1621814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621814400000",
    "number": "1780259663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "636 WAVERLY AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436073836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 WAVERLY AVE",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436073836",
            "telephone_number": "419-214-9302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKYFALL RESIDENTIAL HOMES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-24",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A",
        "authorized_official_last_name": "FAGAN",
        "authorized_official_first_name": "ANTHONYESHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "419-214-9302"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; 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.