MEDICARE: BLUE SKY ADULT CARE, INC.

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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1366097834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE SKY ADULT CARE, INC.

Provider Business Mailing Address
First Line	:	16452 SW 28TH CT
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-5215
Country	:	US
Telephone Number	:	754-423-4691
Fax Number	:

Provider Business Practice Location Address
First Line	:	1351 S STATE ROAD 7
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-4023
Country	:	US
Telephone Number	:	954-736-7227
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KIMBERLY RAMLOCHAN
Credential	:	RN
Telephone Number	:	754-423-4691

Provider Enumeration Date	:	08/01/2019
Last Update Date	:	08/01/2019

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