Healthcare Provider Details

I. General information

NPI: 1548810179
Provider Name (Legal Business Name): BLUE SKY MEDICAL & REHAB CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2337 W 76TH ST
HIALEAH FL
33016-1842
US

IV. Provider business mailing address

2337 W 76TH ST
HIALEAH FL
33016-1842
US

V. Phone/Fax

Practice location:
  • Phone: 786-360-5306
  • Fax: 786-637-2363
Mailing address:
  • Phone: 786-360-5306
  • Fax: 786-637-2363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SUSEL CASADO
Title or Position: MANAGER
Credential:
Phone: 786-360-5306