Provider Demographics
NPI:1518167998
Name:BLUE SKY ADULT DAY CARE
Entity Type:Organization
Organization Name:BLUE SKY ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERA
Authorized Official - Middle Name:PETROVNA
Authorized Official - Last Name:KLIMOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-254-8219
Mailing Address - Street 1:5923 E 114TH PL
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-5553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5923 E 114TH PL
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-5553
Practice Address - Country:US
Practice Address - Phone:303-254-8219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4225362261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO35427086Medicaid