Provider Demographics
NPI:1548810179
Name:BLUE SKY MEDICAL & REHAB CENTER LLC
Entity type:Organization
Organization Name:BLUE SKY MEDICAL & REHAB CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CASADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-360-5306
Mailing Address - Street 1:2337 W 76TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1842
Mailing Address - Country:US
Mailing Address - Phone:786-360-5306
Mailing Address - Fax:786-637-2363
Practice Address - Street 1:2337 W 76TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1842
Practice Address - Country:US
Practice Address - Phone:786-360-5306
Practice Address - Fax:786-637-2363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-16
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty