Organization
BLUE SKY IOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS MOORE (MANAGING MEMBER)
(323) 394-9671
Entity
Organization
Contact information
Practice address
1800 MARTIN LUTHER KING PKWY STE 204, DURHAM, NC 27707-3500
(984) 209-4645
(323) 213-7885
Mailing address
1800 MARTIN LUTHER KING PKWY STE 204, DURHAM, NC 27707-3500
(984) 209-4645
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
04/30/2025
Last updated
05/27/2025
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