Healthcare Provider Details

I. General information

NPI: 1124659503
Provider Name (Legal Business Name): COLORADO BLUESKY ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 NORTHMOOR TER
PUEBLO CO
81008-1505
US

IV. Provider business mailing address

2003 NORTHMOOR TER
PUEBLO CO
81008-1505
US

V. Phone/Fax

Practice location:
  • Phone: 719-542-6701
  • Fax: 719-546-0572
Mailing address:
  • Phone: 719-542-6701
  • Fax: 719-546-0572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MARIAH L SCHOFIELD
Title or Position: CFO
Credential:
Phone: 719-546-6701