Provider Demographics
NPI:1346333275
Name:SKY BLUE HEALTH INC DBA HILLSIDE CARE CENTER
Entity Type:Organization
Organization Name:SKY BLUE HEALTH INC DBA HILLSIDE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:P
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:510-793-3000
Mailing Address - Street 1:38650 MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4391
Mailing Address - Country:US
Mailing Address - Phone:510-793-3000
Mailing Address - Fax:510-745-7300
Practice Address - Street 1:38650 MISSION BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4391
Practice Address - Country:US
Practice Address - Phone:510-793-3000
Practice Address - Fax:510-745-7300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05562LCMedicaid
CAZZR05562LCMedicaid