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Blue Sky Behavioral Health, PLLC.

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Company Details

Name: Blue Sky Behavioral Health, PLLC.
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 05 Sep 2023 (2 years ago)
Financial Date End: 30 Sep 2025
Entity Number: 5383789
Place of Formation: IDAHO
File Number: 896839
ZIP code: 83651
County: Canyon County
Principal Address: 923 16TH AVENUE SOUTH NAMPA, ID 83651

Agent

Name Role Address
Jeffrey Moreno Agent 923 16TH AVENUE SOUTH, NAMPA, ID 83651

Manager

Name Role Address Appointed On
Jeffrey Moreno Manager 923 16TH AVENUE SOUTH, NAMPA, ID 83651 2024-08-06

National Provider Identifier

NPI Number:
1053199778
Certification Date:
2023-09-15

Authorized Person:

Name:
JEFFREY MORENO
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
1041C0700X - Clinical Social Worker
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0005848327 2024-08-06
Initial Filing 0005383789 2023-09-05

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Date of last update: 26 Jul 2025

Sources: Idaho Secretary of State