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SKY LAKE RECOVERY CENTER, LLC
NPI 1487160388
Substance Abuse Rehabilitation Facility in South Lake Tahoe, CA

Active since December 15, 2017CLIA 05D2066722 · Waiver
586 GLORENE AVE, SOUTH LAKE TAHOE, CA 96150(530) 539-9026 Get Directions Write a Review

NPPES record last updated: September 20, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Sep 20, 2022, Dec 15, 2017 (2 updates tracked since 2017).

About Sky Lake Recovery Center, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SKY LAKE RECOVERY CENTER, LLC (NPI 1487160388) is a healthcare organization registered as a substance abuse rehabilitation facility in South Lake Tahoe, California and active in the NPI registry since December 2017. The organization holds a CLIA Waiver certificate valid through October 1, 2027 and lists Nathtan Tuddenham, Chief Operating Officer, as its authorized official.

NPPES Registry Identity

NPI1487160388
Entity TypeOrganization
Primary Taxonomy324500000X
Legal Business NameSKY LAKE RECOVERY CENTER, LLC
Location Address586 GLORENE AVESouth Lake Tahoe, CA 96150-3907
Mailing Address262 Gaffey RdWatsonville, CA 95076-9731 · (831) 740-4629
Phone(530) 539-9026
Organization SubpartNo
Authorized OfficialNathtan TuddenhamChief Operating Officer · (831) 740-4629
Enumeration DateDecember 15, 2017
Last NPPES UpdateSeptember 20, 20222 updates tracked since enumeration
NPPES CertifiedSeptember 20, 2022
✔ NPI 1487160388 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySubstance Abuse Rehabilitation FacilityResidential Treatment Facilities
Taxonomy Code324500000X
Definition
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.
586 GLORENE AVE, South Lake Tahoe, CA 96150
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2066722

Sky Lake Recovery Center, LLC · South Lake Tahoe, CA
Active · expires Oct 1, 2027
CLIA Number05D2066722
Laboratory TypeResid Rehab
Certificate Effective DateOctober 2, 2025
Certificate Expiration DateOctober 1, 2027
Laboratory DirectorAlok Krishna , MD
Laboratory Phone(831) 740-4639
Laboratory LocationSky Lake Recovery Center, LLC586 Glorene Avenue C/O Mason Ungar, South Lake Tahoe, CA 96150
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sky Lake Recovery Center, LLC's NPI number?

The NPI number for Sky Lake Recovery Center, LLC is 1487160388. It was assigned to this organization in the NPPES registry on December 15, 2017.

Where is Sky Lake Recovery Center, LLC located?

Sky Lake Recovery Center, LLC is located at 586 Glorene Ave, South Lake Tahoe, CA 96150. The listed phone number is (530) 539-9026.

What is Sky Lake Recovery Center, LLC's specialty?

The primary specialty registered for this NPI is Substance Abuse Rehabilitation Facility with taxonomy code 324500000X.

Does Sky Lake Recovery Center, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2066722) is associated with this NPI, valid through October 1, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Sky Lake Recovery Center, LLC was last updated on September 20, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.