Provider Demographics
NPI:1316732498
Name:SKY RIDGE LLC
Entity type:Organization
Organization Name:SKY RIDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:TERRENCE
Authorized Official - Last Name:DRAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-317-9628
Mailing Address - Street 1:12570 OLD SEWARD HWY STE 204
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3532
Mailing Address - Country:US
Mailing Address - Phone:907-350-8588
Mailing Address - Fax:
Practice Address - Street 1:10851 SKY RIDGE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-0001
Practice Address - Country:US
Practice Address - Phone:907-891-0543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities