1942604004 NPI number — BLUE SKY TREATMENT

Table of content: (NPI 1942604004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942604004 NPI number — BLUE SKY TREATMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUE SKY TREATMENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942604004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5360 N FEDERAL HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIGHTHOUSE POINT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33064-7068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
754-222-6884
Provider Business Mailing Address Fax Number:
954-746-8232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5360 N FEDERAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIGHTHOUSE POINT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33064-7068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
754-222-6884
Provider Business Practice Location Address Fax Number:
954-746-8232
Provider Enumeration Date:
10/20/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FRIIS
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
754-222-6884

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  1706AD953702 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)