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General NPI Number Information
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NPI Number | 1366581720
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Entity Type | Organization
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Legal Business Name | BLUE LADY INC
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2345 E THOMAS RD SUITE 110
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City | PHOENIX
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State | AZ
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Zip | 85016-7848
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Country | US
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Telephone | 602-283-5050
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Fax | 602-283-5055
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Provider Business Mailing Address
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Address Line | 2345 E THOMAS RD SUITE 110
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City | PHOENIX
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State | AZ
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Zip | 85016-7848
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Country | US
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Telephone | 602-283-5050
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Fax | 602-283-5055
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Authorized Official
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Title or Position | PRESIDENT
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Name | MERIDELL SLOTEREEK
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Credential |
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Telephone | 602-283-5050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | NOT REQUIRED
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License Number State | AZ
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