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NPI Code Detail

MEDICARE: BLUE LAKE HOMECARE MI, LLC

MEDICARE: BLUE LAKE HOMECARE MI, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1253Z00000XIn Home Supportive Care Agency

General Provider Information

NPI Number : 1770415176
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUE LAKE HOMECARE MI, LLC
Provider Business Mailing Address
First Line : 1515 PINE ST STE 230
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-4994
Country : US
Telephone Number : 313-546-0363
Fax Number :
Provider Business Practice Location Address
First Line : 2222 W GRAND RIVER AVE STE A
Second Line :
City : OKEMOS
State : MI
Zip : 48864-1604
Country : US
Telephone Number : 313-546-0363
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : ASHER KLUGMANN
Credential :
Telephone Number : 313-546-0363
Provider Enumeration Date : 06/01/2026
Last Update Date : 06/02/2026

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Directions to “BLUE LAKE HOMECARE MI, LLC ” Practice Location

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