Basic Information
| Provider Information | |||||||||
| NPI: | 1639359391 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BLUE SKY HOSPICE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60189 | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784660189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3617231049 | ||||||||
| FaxNumber: | 3617231056 | ||||||||
| Practice Location | |||||||||
| Address1: | 4444 CORONA DR | ||||||||
| Address2: | SUITE 139 | ||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784114317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3617231049 | ||||||||
| FaxNumber: | 3617231056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2007 | ||||||||
| LastUpdateDate: | 08/08/2011 | ||||||||
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| AuthorizedOfficialLastName: | READ | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SR VICE PRESIDENT/ CFO | ||||||||
| AuthorizedOfficialTelephone: | 3617231049 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
No ID Information.