Provider Demographics
NPI:1366233801
Name:BLUESKY PRIME CARE LLC
Entity type:Organization
Organization Name:BLUESKY PRIME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ODOWAA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-986-5653
Mailing Address - Street 1:6819 PARK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-2221
Mailing Address - Country:US
Mailing Address - Phone:763-300-2242
Mailing Address - Fax:
Practice Address - Street 1:6819 PARK RIDGE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2221
Practice Address - Country:US
Practice Address - Phone:763-300-2242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities