Provider Demographics
NPI:1225709587
Name:BLUE SKIES HOLISTIC CARE, INC.
Entity Type:Organization
Organization Name:BLUE SKIES HOLISTIC CARE, INC.
Other - Org Name:KELEMARIE LYONS ACUPUNCTURE & HERBAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELEMARIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:414-737-6000
Mailing Address - Street 1:20515 MILTON CT
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-4050
Mailing Address - Country:US
Mailing Address - Phone:414-737-6000
Mailing Address - Fax:
Practice Address - Street 1:9205 W CENTER ST STE 209
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-4548
Practice Address - Country:US
Practice Address - Phone:414-737-6000
Practice Address - Fax:414-677-6979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-25
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty