Provider Demographics
NPI:1902818305
Name:BLUE SKIES HOSPICE INC
Entity Type:Organization
Organization Name:BLUE SKIES HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS, CNS,
Authorized Official - Phone:219-554-0688
Mailing Address - Street 1:1520 PROVIDENT DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3291
Mailing Address - Country:US
Mailing Address - Phone:574-372-3800
Mailing Address - Fax:574-372-3810
Practice Address - Street 1:2714 169TH ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46323-1508
Practice Address - Country:US
Practice Address - Phone:219-554-0688
Practice Address - Fax:219-554-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1932171634OtherFAMILY NURSE PRACTITIONER