Provider Demographics
NPI:1073745618
Name:BLUE SKIES OF NC, LLC
Entity Type:Organization
Organization Name:BLUE SKIES OF NC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PROGRAM DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEVOHN
Authorized Official - Middle Name:PARIS
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:BA QMHP
Authorized Official - Phone:919-358-7019
Mailing Address - Street 1:212 N CORCORAN ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-3210
Mailing Address - Country:US
Mailing Address - Phone:919-683-8672
Mailing Address - Fax:919-683-8710
Practice Address - Street 1:212 N CORCORAN ST
Practice Address - Street 2:SUITE 214
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3210
Practice Address - Country:US
Practice Address - Phone:919-683-8672
Practice Address - Fax:919-683-8710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-16
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24537251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health