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General NPI Number Information
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NPI Number | 1922960186
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Entity Type | Organization
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Legal Business Name | BLUE WOLF INDUSTRY LLC
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Dates
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Enumeration Date | 11/25/2025
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 27691 SOMERSET ST
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City | INKSTER
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State | MI
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Zip | 48141-1220
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Country | US
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Telephone | 586-241-9196
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Fax |
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Provider Business Mailing Address
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Address Line | 1316 S WAYNE RD
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City | WESTLAND
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State | MI
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Zip | 48186-5438
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Country | US
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Telephone | 586-241-9196
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Fax |
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | INTRINSIC BLUE WOLF
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Credential |
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Telephone | 586-241-9196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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