Healthcare Provider Details

I. General information

NPI: 1538613823
Provider Name (Legal Business Name): COLORADO BLUESKY ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2016
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: 719-542-3522
Mailing address:
  • Phone: 719-542-6701
  • Fax: 719-542-3522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARIAH SCHOFIELD
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 719-542-6701