Basic Information
| Provider Information | |||||||||
| NPI: | 1700219813 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OPEN SKIES HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 N CENTRAL AVE | ||||||||
| Address2: | SUITE 1050 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850041133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022668402 | ||||||||
| FaxNumber: | 6022640887 | ||||||||
| Practice Location | |||||||||
| Address1: | 707 BROADWAY BLVD NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871022360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053458471 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2013 | ||||||||
| LastUpdateDate: | 08/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | HENNING | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6022854340 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.