Organization
BLUE LIGHT INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PHYLLIS CLARK (EXECUTIVE DIRECTOR)
(313) 999-4890
Entity
Organization
Contact information
Practice address
26105 ORCHARD LAKE RD SUITE #208 FARMINGTON HILLS MI 48, 35115 E MICHIGAN AVE, WAYNE, MI 48184
(248) 615-3042
(248) 615-3047
Mailing address
26105 ORCHARD LAKE RD, SUITE #208, FARMINGTON HILLS, MI 48334-4576
(248) 615-3042
(248) 615-3047
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1693530
—
MI
Enumeration date
06/09/2014
Last updated
11/22/2024
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