# WOOD LANE RESIDENTIAL SERVICES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215029525
- **Authorized official:** JESSICA BLAKELY (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (419) 353-9577

## Contact information

- **Practice address:** 349 W MAIN ST., PORTAGE, OH 43451
- **Practice address phone:** (419) 353-9577
- **Mailing address:** 545 PEARL ST, BOWLING GREEN, OH 43402-2731
- **Mailing address phone:** (419) 353-9577

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | OH | — |
| 385HR2060X | Child Intellectual and/or Developmental Disabilities Respite Care | — | OH | Yes |

## Other

- **Enumeration date:** 09/28/2006
- **Last updated:** 07/21/2022