Healthcare Provider Details

I. General information

NPI: 1881250025
Provider Name (Legal Business Name): BLUE SKY MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 N WILSHIRE AVE
ANAHEIM CA
92801-1335
US

IV. Provider business mailing address

280 N WILSHIRE AVE
ANAHEIM CA
92801-1335
US

V. Phone/Fax

Practice location:
  • Phone: 714-844-2667
  • Fax:
Mailing address:
  • Phone: 714-844-2667
  • Fax: 714-844-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: ALBERT ZAKARYAN
Title or Position: CEO
Credential:
Phone: 714-844-2667