Provider Demographics
NPI:1366581720
Name:BLUE LADY INC
Entity type:Organization
Organization Name:BLUE LADY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MERIDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOTEREEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-283-5050
Mailing Address - Street 1:2345 E THOMAS RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7848
Mailing Address - Country:US
Mailing Address - Phone:602-283-5050
Mailing Address - Fax:602-283-5055
Practice Address - Street 1:2345 E THOMAS RD
Practice Address - Street 2:SUITE 110
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7848
Practice Address - Country:US
Practice Address - Phone:602-283-5050
Practice Address - Fax:602-283-5055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNOT REQUIRED251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ985442OtherAHCCCS ID PROVIDER #