Provider Demographics
NPI:1538613823
Name:COLORADO BLUESKY ENTERPRISES, INC.
Entity type:Organization
Organization Name:COLORADO BLUESKY ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-542-6701
Mailing Address - Street 1:2003 NORTHMOOR TER
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1505
Mailing Address - Country:US
Mailing Address - Phone:719-542-6701
Mailing Address - Fax:719-542-3522
Practice Address - Street 1:2003 NORTHMOOR TER
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1505
Practice Address - Country:US
Practice Address - Phone:719-542-6701
Practice Address - Fax:719-542-3522
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO BLUESKY ENTERPRISES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-04
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86379321Medicaid