MEDICARE: BLUESKY HEALTHCARE SERVICES, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1174412357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUESKY HEALTHCARE SERVICES, LLC.

Provider Business Mailing Address
First Line	:	36 THRUSH RD
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20164-1616
Country	:	US
Telephone Number	:	703-898-6657
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 THRUSH RD
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20164-1616
Country	:	US
Telephone Number	:	703-898-6657
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FATOUMATA BALDE
Credential	:
Telephone Number	:	703-898-6657

Provider Enumeration Date	:	07/01/2025
Last Update Date	:	07/21/2025

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