Provider Demographics
NPI:1750077327
Name:GRAY SKIES BLUE LLC
Entity type:Organization
Organization Name:GRAY SKIES BLUE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JANAKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:814-931-1758
Mailing Address - Street 1:423 S CLEARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-3329
Mailing Address - Country:US
Mailing Address - Phone:814-931-1758
Mailing Address - Fax:
Practice Address - Street 1:1732 LYTER DR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-1206
Practice Address - Country:US
Practice Address - Phone:814-931-1758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty