Provider Demographics
NPI:1245647387
Name:BLUE SKIES HOME MANAGMENT SERVICES
Entity type:Organization
Organization Name:BLUE SKIES HOME MANAGMENT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:O
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:OWNER
Authorized Official - Last Name:ADAIR
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:928-246-8990
Mailing Address - Street 1:7581 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-8615
Mailing Address - Country:US
Mailing Address - Phone:928-261-3673
Mailing Address - Fax:928-726-5014
Practice Address - Street 1:7581 E 26TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-8615
Practice Address - Country:US
Practice Address - Phone:928-261-3673
Practice Address - Fax:928-726-5014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ004053052014305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization