Provider Demographics
NPI:1417675513
Name:BLUE SKY ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:BLUE SKY ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-540-1948
Mailing Address - Street 1:3317 S HIGLEY RD PMB 106
Mailing Address - Street 2:SUITE 114
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297
Mailing Address - Country:US
Mailing Address - Phone:480-540-1948
Mailing Address - Fax:
Practice Address - Street 1:2065 N VISTA DEL SOL
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-2143
Practice Address - Country:US
Practice Address - Phone:480-357-2565
Practice Address - Fax:480-885-4865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances