Organization
BLACKWELL HOMES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLARD BLACKWELL MA (CFO)
(707) 575-5387
Entity
Organization
Contact information
Practice address
1646 S WRIGHT RD, SANTA ROSA, CA 95407-7318
(707) 575-5387
(707) 570-2647
Mailing address
PO BOX 8578, SANTA ROSA, CA 95407-1578
(707) 575-5387
(707) 570-2647
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
496800053
CA
Other
Enumeration date
01/26/2010
Last updated
01/26/2010
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