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General NPI Number Information
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NPI Number | 1053235325
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Entity Type | Organization
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Legal Business Name | BLUEBIRD SKY LLC
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Dates
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Enumeration Date | 08/07/2026
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Last Update Date | 08/07/2026
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Provider Practice Location Address
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Address Line | 17132 SE MANLEY ST
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City | PORTLAND
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State | OR
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Zip | 97236-4784
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Country | US
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Telephone | 971-238-8977
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Fax |
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Provider Business Mailing Address
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Address Line | 140 SW COLUMBIA ST APT 1229
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City | PORTLAND
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State | OR
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Zip | 97201-5886
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JC KANYEMERA
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Credential |
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Telephone | 971-238-8977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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