Blue Light Inc.

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Legal business name

BLUE LIGHT INC.

Practice address

26105 Orchard Lake Rd Suite #208 Farmington Hills Mi 48
35115 E Michigan Ave
Wayne, MI 48184

Phone

(248) 615-3042

Fax

(248) 615-3047

NPI assigned

Jun 9, 2014

Last updated

Nov 22, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Phyllis Clark

Title

Executive Director

Phone

(313) 999-4890

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732233600000",
    "number": "1497168215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26105 ORCHARD LAKE RD",
            "address_2": "SUITE #208",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483344576",
            "telephone_number": "248-615-3042",
            "fax_number": "248-615-3047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26105 ORCHARD LAKE RD SUITE #208 FARMINGTON HILLS MI 48",
            "address_2": "35115 E MICHIGAN AVE",
            "city": "WAYNE",
            "state": "MI",
            "postal_code": "48184",
            "telephone_number": "248-615-3042",
            "fax_number": "248-615-3047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE LIGHT INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-09",
        "last_updated": "2024-11-22",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "313-999-4890",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1693530",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Developmental Disabilities Clinic/Center in Wayne, MI
• Providers in Wayne, MI by specialty
• Developmental Disabilities Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.