Organization
WOOD LANE RESIDENTIAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA BLAKELY (CEO)
(419) 353-9577
Entity
Organization
Contact information
Practice address
531 CONNEAUT AVE, BOWLING GREEN, OH 43402-2237
(419) 353-2307
Mailing address
545 PEARL ST, BOWLING GREEN, OH 43402-2784
(419) 353-9577
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Enumeration date
04/28/2020
Last updated
04/28/2020
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