Healthcare Provider Details

I. General information

NPI: 1801600960
Provider Name (Legal Business Name): BLUE SKY ADHC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 IMPERIAL HWY, UNIT R
DOWNEY CA
90242-3466
US

IV. Provider business mailing address

6315 ETHEL AVE
VAN NUYS CA
91401-2524
US

V. Phone/Fax

Practice location:
  • Phone: 562-999-9935
  • Fax: 562-999-9934
Mailing address:
  • Phone: 562-999-9935
  • Fax: 562-999-9934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GAYANE KIRAKOSYAN
Title or Position: PRESIDENT
Credential:
Phone: 562-999-9935