NPIMap

Organization Active NPI

Wood Lane Residential Services, Inc.

  • Child Intellectual and/or Developmental Disabilities Respite Care
  • Portage, OH
National Provider Identifier
1215029525
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child Intellectual and/or Developmental Disabilities Respite CareTaxonomy code 385HR2060X
Legal business name
WOOD LANE RESIDENTIAL SERVICES, INC.
Practice address
349 W Main St.
Portage, OH 43451
Phone
(419) 353-9577
NPI assigned
Sep 28, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X OH
Child Intellectual and/or Developmental Disabilities Respite Care 385HR2060X OH Primary

Addresses

Primary practice location

349 W Main St.
Portage, OH 43451

Mailing address

545 Pearl St
Bowling Green, OH 43402-2731
Phone (419) 353-9577

Other practice location 1

1005 Klotz Rd
Bowling Green, OH 43402-4820
Phone (419) 353-9577

Other practice location 2

1009 Klotz Rd
Bowling Green, OH 43402-4820
Phone (419) 353-9577

Other identifiers 9

IdentifierTypeStateIssuer
36G344MedicaidOH
36G345MedicaidOH
36G260MedicaidOH
36G475MedicaidOH
36G087MedicaidOH
36G261MedicaidOH
2585751MedicaidOH
36G381MedicaidOH
36G474MedicaidOH

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

1005 Klotz Rd
Bowling Green, OH 43402
Phone (419) 352-5115

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1215029525",
    "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": "434022731",
            "telephone_number": "419-353-9577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "349 W MAIN ST.",
            "city": "PORTAGE",
            "state": "OH",
            "postal_code": "43451",
            "telephone_number": "419-353-9577"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1005 Klotz Rd",
            "address_purpose": "LOCATION",
            "city": "Bowling Green",
            "state": "OH",
            "postal_code": "434024820",
            "country_code": "US",
            "telephone_number": "419-353-9577",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1009 Klotz Rd",
            "address_purpose": "LOCATION",
            "city": "Bowling Green",
            "state": "OH",
            "postal_code": "434024820",
            "country_code": "US",
            "telephone_number": "419-353-9577",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WOOD LANE RESIDENTIAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2022-07-21",
        "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": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "OH",
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36G344",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36G345",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36G260",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36G475",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36G087",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36G261",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2585751",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36G381",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36G474",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.