Healthcare Provider Details

I. General information

NPI: 1245150200
Provider Name (Legal Business Name): BLUE HEAVENS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 N DENWOOD ST
DEARBORN MI
48128-1568
US

IV. Provider business mailing address

936 N DENWOOD ST
DEARBORN MI
48128-1568
US

V. Phone/Fax

Practice location:
  • Phone: 313-463-0012
  • Fax:
Mailing address:
  • Phone: 313-463-0012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. NOOR ASSI
Title or Position: OWNER
Credential: MS, BCBA, LBA
Phone: 313-463-0012