Healthcare Provider Details

I. General information

NPI: 1013605112
Provider Name (Legal Business Name): LH BLUE SKY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19520 PINE CANYON RD
LAKE HUGHES CA
93532-1149
US

IV. Provider business mailing address

19520 PINE CANYON RD
LAKE HUGHES CA
93532-1149
US

V. Phone/Fax

Practice location:
  • Phone: 323-949-2030
  • Fax:
Mailing address:
  • Phone: 323-649-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. GOR HABESHIAN
Title or Position: CEO
Credential:
Phone: 323-649-2030