Provider Demographics
NPI:1013605112
Name:LH BLUE SKY INC
Entity Type:Organization
Organization Name:LH BLUE SKY INC
Other - Org Name:LAKE HUGHES RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GOR
Authorized Official - Middle Name:
Authorized Official - Last Name:HABESHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-949-2030
Mailing Address - Street 1:19520 PINE CANYON RD
Mailing Address - Street 2:
Mailing Address - City:LAKE HUGHES
Mailing Address - State:CA
Mailing Address - Zip Code:93532-1149
Mailing Address - Country:US
Mailing Address - Phone:323-949-2030
Mailing Address - Fax:
Practice Address - Street 1:19520 PINE CANYON RD
Practice Address - Street 2:
Practice Address - City:LAKE HUGHES
Practice Address - State:CA
Practice Address - Zip Code:93532-1149
Practice Address - Country:US
Practice Address - Phone:323-949-2030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder