Provider Demographics
NPI:1821561788
Name:CLEAR SKYE MEDICAL HOLDINGS, LLC
Entity Type:Organization
Organization Name:CLEAR SKYE MEDICAL HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAJENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAFNA
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:864-631-7371
Mailing Address - Street 1:1035 MEDICAL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-4542
Mailing Address - Country:US
Mailing Address - Phone:864-547-2089
Mailing Address - Fax:864-547-2086
Practice Address - Street 1:1035 MEDICAL RIDGE RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-4542
Practice Address - Country:US
Practice Address - Phone:864-547-2089
Practice Address - Fax:864-547-2086
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEAR SKYE MEDICAL HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-03
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone