Provider Demographics
NPI:1962167163
Name:SKY BLUE SKY CORP
Entity type:Organization
Organization Name:SKY BLUE SKY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:STANKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-997-4344
Mailing Address - Street 1:3337 N MILLER RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6495
Mailing Address - Country:US
Mailing Address - Phone:847-997-4344
Mailing Address - Fax:
Practice Address - Street 1:3337 N MILLER RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6495
Practice Address - Country:US
Practice Address - Phone:847-997-4344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SKY BLUE SKY CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-02
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy