Active NPI
Shari Blackburn
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- Fort Gratiot, MI
National Provider Identifier
1174850002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment Facility
- License
- AF740302832
- Practice address
- 3399 Oxbow Dr
Fort Gratiot, MI 48059-4124 - Phone
- (810) 990-8134
- NPI assigned
- Nov 13, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Residential Treatment Facility | 320600000X | AF740302832 | MI | Primary |
Addresses
Primary practice location
3399 Oxbow Dr
Fort Gratiot, MI 48059-4124
Mailing address
3399 Oxbow Dr
Fort Gratiot, MI 48059-4124
Phone (810) 990-8134
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AF740302832 | MI | MD | Intellectual and/or Developmental Disabilities Residential Treatment Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1258070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258070400000",
"number": "1174850002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3399 OXBOW DR",
"city": "FORT GRATIOT",
"state": "MI",
"postal_code": "480594124",
"telephone_number": "810-990-8134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3399 OXBOW DR",
"city": "FORT GRATIOT",
"state": "MI",
"postal_code": "480594124",
"telephone_number": "810-990-8134"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKBURN",
"first_name": "SHARI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-11-13",
"last_updated": "2009-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "320600000X",
"taxonomy_group": "",
"desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": "MI",
"license": "AF740302832",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Gratiot, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.