Provider Demographics
NPI:1588048185
Name:BLUE SKY ASSISTED LIVING
Entity type:Organization
Organization Name:BLUE SKY ASSISTED LIVING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-540-1948
Mailing Address - Street 1:3317 S HIGLEY RD
Mailing Address - Street 2:SUITE 114 PMB 106
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-5436
Mailing Address - Country:US
Mailing Address - Phone:480-540-1948
Mailing Address - Fax:800-509-9446
Practice Address - Street 1:2202 N SANTA ANNA CT
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2161
Practice Address - Country:US
Practice Address - Phone:480-726-1906
Practice Address - Fax:480-726-2568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4605323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility