MEDICARE: BLUE SKIES HOSPICE 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	305S00000X	Point of Service

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1932171634	OTHER	IN	FAMILY NURSE PRACTITIONER

General Provider Information

NPI Number	:	1902818305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE SKIES HOSPICE INC

Provider Business Mailing Address
First Line	:	1520 PROVIDENT DR
Second Line	:
City	:	WARSAW
State	:	IN
Zip	:	46580-3291
Country	:	US
Telephone Number	:	574-372-3800
Fax Number	:	574-372-3810

Provider Business Practice Location Address
First Line	:	2714 169TH ST
Second Line	:
City	:	HAMMOND
State	:	IN
Zip	:	46323-1508
Country	:	US
Telephone Number	:	219-554-0688
Fax Number	:	219-554-1773

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. LISA GUZMAN
Credential	:	R.N., M.S., C.N.S.,
Telephone Number	:	219-554-0688

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	05/15/2019

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Directions to “BLUE SKIES HOSPICE INC ” Practice Location

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