Provider Demographics
NPI:1801600960
Name:BLUE SKY ADHC, LLC
Entity type:Organization
Organization Name:BLUE SKY ADHC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GAYANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRAKOSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-999-9935
Mailing Address - Street 1:6315 ETHEL AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-2524
Mailing Address - Country:US
Mailing Address - Phone:562-999-9935
Mailing Address - Fax:562-999-9934
Practice Address - Street 1:7700 IMPERIAL HWY, UNIT R
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-3466
Practice Address - Country:US
Practice Address - Phone:562-999-9935
Practice Address - Fax:562-999-9934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care