Healthcare Provider Details

I. General information

NPI: 1699594978
Provider Name (Legal Business Name): BLUE SKY COMMUNITY MENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 SW 124TH AVE STE 204B1
MIAMI FL
33183-4627
US

IV. Provider business mailing address

8501 SW 124TH AVE STE 204B1
MIAMI FL
33183-4627
US

V. Phone/Fax

Practice location:
  • Phone: 786-442-4002
  • Fax:
Mailing address:
  • Phone: 786-442-4002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JORGE PERERA
Title or Position: OFFICER
Credential:
Phone: 786-442-4002