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General NPI Number Information
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NPI Number | 1104324367
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Entity Type | Organization
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Legal Business Name | BLUE LYTE INC.
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 35115 E MICHIGAN AVE
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City | WAYNE
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State | MI
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Zip | 48184-1660
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Country | US
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Telephone | 248-615-3042
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Fax | 248-615-3047
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Provider Business Mailing Address
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Address Line | 35115 E MICHIGAN AVE
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City | WAYNE
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State | MI
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Zip | 48184-1660
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Country | US
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Telephone | 248-615-3042
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Fax | 248-615-3047
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | PHYLLIS CLARK
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Credential |
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Telephone | 248-615-3042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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