Provider Demographics
NPI:1386943710
Name:SKK,LLC
Entity type:Organization
Organization Name:SKK,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:ALVAREZ
Authorized Official - Last Name:CAVANAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-347-8288
Mailing Address - Street 1:25166 MARION AVE
Mailing Address - Street 2:UNIT 114
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-4017
Mailing Address - Country:US
Mailing Address - Phone:941-347-8288
Mailing Address - Fax:800-547-2557
Practice Address - Street 1:25166 MARION AVE
Practice Address - Street 2:UNIT 114
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4017
Practice Address - Country:US
Practice Address - Phone:941-347-8288
Practice Address - Fax:800-547-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211457253Z00000X
FL230886253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care