Provider Demographics
NPI:1487843694
Name:IAN MARK GEWIN
Entity Type:Organization
Organization Name:IAN MARK GEWIN
Other - Org Name:BLUE SKIES HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:GEWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:816-662-2583
Mailing Address - Street 1:16944 COUNTY ROAD 3082
Mailing Address - Street 2:
Mailing Address - City:COSBY
Mailing Address - State:MO
Mailing Address - Zip Code:64436-8107
Mailing Address - Country:US
Mailing Address - Phone:816-662-2583
Mailing Address - Fax:816-662-2525
Practice Address - Street 1:16944 COUNTY ROAD 3082
Practice Address - Street 2:
Practice Address - City:COSBY
Practice Address - State:MO
Practice Address - Zip Code:64436-8107
Practice Address - Country:US
Practice Address - Phone:816-662-2583
Practice Address - Fax:816-662-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management