Provider Demographics
NPI:1376175737
Name:BLUE SKY BEHAVIORAL SERVICES, INC
Entity Type:Organization
Organization Name:BLUE SKY BEHAVIORAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUCIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:GRANCHAMPS
Authorized Official - Suffix:
Authorized Official - Credentials:BAS
Authorized Official - Phone:321-339-6156
Mailing Address - Street 1:291 AWIN CIR SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-8563
Mailing Address - Country:US
Mailing Address - Phone:321-339-6156
Mailing Address - Fax:
Practice Address - Street 1:291 AWIN CIR SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-8563
Practice Address - Country:US
Practice Address - Phone:321-339-6156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE SKY BEHAVIORAL SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities