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Organization
BRIGHT LAKE CARE LLC
Active
Organization
BRIGHT LAKE CARE LLC
Active
Other names
Bright Lake Care
Organization subpart
No
Provider details
NPI number
Authorized official
TARIQ ALI (OWNER)
(612) 800-4209
Entity
Organization
Contact information
Practice address
3845 HIAWATHA AVE APT 509, MINNEAPOLIS, MN 55406-4454
(612) 800-4209
Mailing address
3845 HIAWATHA AVE APT 509, MINNEAPOLIS, MN 55406-4454
(612) 800-4209
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
NULL
Other
Enumeration date
10/23/2024
Last updated
05/13/2025
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