Provider Demographics
NPI:1710581905
Name:BLUE SKY AHEAD LLC
Entity Type:Organization
Organization Name:BLUE SKY AHEAD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:WOODBURN
Authorized Official - Last Name:COMEAU
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP BC
Authorized Official - Phone:917-693-8488
Mailing Address - Street 1:461 MAIN ST STE 6C
Mailing Address - Street 2:
Mailing Address - City:FRANCONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03580-4836
Mailing Address - Country:US
Mailing Address - Phone:603-823-2074
Mailing Address - Fax:
Practice Address - Street 1:461 MAIN ST STE 6B
Practice Address - Street 2:
Practice Address - City:FRANCONIA
Practice Address - State:NH
Practice Address - Zip Code:03580-4835
Practice Address - Country:US
Practice Address - Phone:603-823-2074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-28
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3118165Medicaid