Provider Demographics
NPI:1952521304
Name:BLUE SKIES HEALTH CARE, INC.
Entity type:Organization
Organization Name:BLUE SKIES HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:LEFELDREN
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:336-337-5102
Mailing Address - Street 1:P.O. BOX 7204
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27417
Mailing Address - Country:US
Mailing Address - Phone:336-292-6611
Mailing Address - Fax:336-852-0064
Practice Address - Street 1:4107 ELLISTON ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-6405
Practice Address - Country:US
Practice Address - Phone:336-294-1789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409390Medicaid