Provider Demographics
NPI:1972330538
Name:BLUE SKIES HEALTHCARE LLC
Entity type:Organization
Organization Name:BLUE SKIES HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYASHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KENNEBREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:762-720-5029
Mailing Address - Street 1:1350 15TH AVE STE 135015TH
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-2308
Mailing Address - Country:US
Mailing Address - Phone:762-720-5029
Mailing Address - Fax:
Practice Address - Street 1:1350 15TH AVE STE 135015TH
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2308
Practice Address - Country:US
Practice Address - Phone:762-720-5029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health