Provider Demographics
NPI:1285068221
Name:BLUE SKIES HOSPICE, LLC
Entity type:Organization
Organization Name:BLUE SKIES HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMEO
Authorized Official - Middle Name:N
Authorized Official - Last Name:MANALO
Authorized Official - Suffix:SR
Authorized Official - Credentials:MBA
Authorized Official - Phone:626-338-7182
Mailing Address - Street 1:570 N TOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-4826
Mailing Address - Country:US
Mailing Address - Phone:626-338-7182
Mailing Address - Fax:626-338-7609
Practice Address - Street 1:570 N TOWNE AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-4826
Practice Address - Country:US
Practice Address - Phone:626-338-7182
Practice Address - Fax:626-338-7609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X
CA550002888251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based