Healthcare Provider Details

I. General information

NPI: 1770415176
Provider Name (Legal Business Name): BLUE LAKE HOMECARE MI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W GRAND RIVER AVE STE A
OKEMOS MI
48864-1604
US

IV. Provider business mailing address

1515 PINE ST STE 230
LAKEWOOD NJ
08701-4994
US

V. Phone/Fax

Practice location:
  • Phone: 313-546-0363
  • Fax:
Mailing address:
  • Phone: 313-546-0363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ASHER KLUGMANN
Title or Position: DIRECTOR
Credential:
Phone: 313-546-0363