MEDICARE: BLUE SKY TREATMENT, 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1679915078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE SKY TREATMENT, LLC

Provider Business Mailing Address
First Line	:	5360 N FEDERAL HWY
Second Line	:	SUITE D
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-7068
Country	:	US
Telephone Number	:	561-866-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	5360 N FEDERAL HWY
Second Line	:	SUITE D
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-7068
Country	:	US
Telephone Number	:	561-866-5900
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. ANDREW FRIIS
Credential	:
Telephone Number	:	561-866-5900

Provider Enumeration Date	:	07/25/2013
Last Update Date	:	06/22/2015

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