Provider Demographics
NPI:1235950569
Name:SKYBLUE AM INC
Entity type:Organization
Organization Name:SKYBLUE AM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTANON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:661-369-2527
Mailing Address - Street 1:14713 PLUMERIA CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93314-8522
Mailing Address - Country:US
Mailing Address - Phone:661-369-2527
Mailing Address - Fax:
Practice Address - Street 1:14713 PLUMERIA CT
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93314-8522
Practice Address - Country:US
Practice Address - Phone:661-369-2527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-19
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization