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
—
—
Other
Enumeration date
10/23/2024
Last updated
05/13/2025
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