Provider Demographics
NPI:1750163234
Name:BLUE SKY VAN RIDES LLC
Entity type:Organization
Organization Name:BLUE SKY VAN RIDES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:RAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-482-7424
Mailing Address - Street 1:7041 WILLOW SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-4784
Mailing Address - Country:US
Mailing Address - Phone:708-482-7424
Mailing Address - Fax:
Practice Address - Street 1:7041 WILLOW SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-4784
Practice Address - Country:US
Practice Address - Phone:708-482-7424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)