- Enrollment id
- O20070720000781
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1962540567
- Multiple npi flag
- N
- Ccn
- 058475
- Associate id
- 4880795848
- Organization name
- BLUE SKY HOME HEALTH, INC.
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 15545 DEVONSHIRE ST
- Address line 2
- STE 206
- City
- MISSION HILLS
- State
- CA
- Zip code
- 913452655