NPIMap

Organization Active NPI

Wood Lane Residential Services, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Bowling Green, OH
National Provider Identifier
1144759739
Registry record updated Jun 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
32699 Issued in OH
Legal business name
WOOD LANE RESIDENTIAL SERVICES, INC.
Practice address
1009 Klotz Rd
Bowling Green, OH 43402-4820
Phone
(419) 353-9577
NPI assigned
Jun 7, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jessica Blakely
Title
Chief Executive Officer
Phone
(419) 353-9577

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 32699 OH Primary

Addresses

Primary practice location

1009 Klotz Rd
Bowling Green, OH 43402-4820

Mailing address

545 Pearl St
Bowling Green, OH 43402-2784

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G475

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
WOOD LANE RESIDENTIAL SERVICES
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jul 28, 1993
Last certification
Jan 28, 2025
Beds
8
Ownership / control type
Private (non-profit)
Facility address
1009 Klotz Road
Bowling Green, OH 43402

National Provider Directory

National Provider Directory
Tax ID family
Wood Lane Residential Services8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

545 Pearl St
Bowling Green, OH 43402

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1496793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496793600000",
    "number": "1144759739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 PEARL ST",
            "city": "BOWLING GREEN",
            "state": "OH",
            "postal_code": "434022784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 KLOTZ RD",
            "city": "BOWLING GREEN",
            "state": "OH",
            "postal_code": "434024820",
            "telephone_number": "419-353-9577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOOD LANE RESIDENTIAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-07",
        "last_updated": "2017-06-07",
        "status": "A",
        "authorized_official_last_name": "BLAKELY",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "419-353-9577"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "OH",
            "license": "32699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, OH

Sources for this page

Verify at the official NPI Registry.