WOOD LANE RESIDENTIAL SERVICES, INC. (NPI# 1215029525) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215029525 |
| Entity Type | Organization |
| Organization Name | WOOD LANE RESIDENTIAL SERVICES, INC. |
| Practice Address |
349 W Main St. Portage OH 43451 |
| Mailing Address |
545 Pearl St Bowling Green OH 43402-2731 |
| Practice Telephone | 4193539577 |
| Mailing Telephone | (419) 353-9577 |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2018-03-17 |
| Authorized Official Name | JESSICA BLAKELY (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 4193539577 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | OH | Residential Treatment Facilities | |
| Y | 385HR2060X |
Respite Care Specialization: Respite Care, Mental Retardation and/or Developmental Disabilities, Child |
OH | Respite Care Facility |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 36G087 | 05 | |
| OH | 36G260 | 05 | |
| OH | 36G344 | 05 | |
| OH | 2585751 | 05 | |
| OH | 36G345 | 05 | |
| OH | 36G475 | 05 | |
| OH | 36G474 | 05 | |
| OH | 36G381 | 05 | |
| OH | 36G261 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1009 Klotz Rd, Bowling Green, OH 434024820 | 4193539577 | |
| 1005 Klotz Rd, Bowling Green, OH 434024820 | 4193539577 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275154569 | Wood Lane Residential Services, Inc. | Intermediate Care Facility, Mentally Retarded | 353 W Main St, Portage, OH 43451-9802 | 2020-04-28 |
| 1144759739 | Wood Lane Residential Services, Inc. | Intermediate Care Facility, Mentally Retarded | 1009 Klotz Rd, Bowling Green, OH 43402-4820 | 2017-06-07 |
| 1528596467 | Wood Lane Residential Services, Inc. | Intermediate Care Facility, Mentally Retarded | 1005 Klotz Rd, Bowling Green, OH 43402-4820 | 2017-05-23 |
| Street Address |
349 W MAIN ST. |
| City | PORTAGE |
| State | OH |
| Zip Code | 43451 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982144853 | Ben Bembry | Driver | 207 S Findlay Pike, Portage, OH 43451 | 2017-02-27 |
| 1295980324 | Wood County Board of Mr/dd | Nursing Care | 351 W. Main Street, Portage, OH 43451 | 2008-11-17 |
| 1861647901 | Wood County Board of Mr/dd | Nursing Care | 355 W. Main Street, Portage, OH 43451 | 2008-11-17 |
| 1043465198 | Wood County Board of Mr/dd | Nursing Care | 353 W. Main Street, Portage, OH 43451 | 2008-11-17 |
| 1972087161 | Danielle R Geroski | Nurse Practitioner | 9900 Huffman Rd, Portage, OH 43451-9739 | 2018-09-24 |
| 1063686830 | Christine Linn Warner | Licensed Practical Nurse | 15590 Greensburg Pike, Portage, OH 43451-9764 | 2008-04-14 |
| 1205449923 | Patricia Lynn Naus | Physical Therapist | 13832 Powell Rd, Portage, OH 43451-9770 | 2020-08-24 |
| 1144841438 | Wood Lane Residential Services | Intermediate Care Facility, Mentally Retarded | 355 W Main St., Portage, OH 43451-9802 | 2020-04-28 |
| 1275154569 | Wood Lane Residential Services, Inc. | Intermediate Care Facility, Mentally Retarded | 353 W Main St, Portage, OH 43451-9802 | 2020-04-28 |
| 1316568603 | Wood Lane Residential Services | Intermediate Care Facility, Mentally Retarded | 351 W Main St, Portage, OH 43451-9802 | 2020-04-28 |
| Find all providers in zip 43451 | ||||
| Taxonomy Code | 385HR2060X |
| Grouping | Respite Care Facility |
| Classification | Respite Care |
| Specialization | Respite Care, Mental Retardation and/or Developmental Disabilities, Child |
| A facility or distinct part of a facility that provides short term, residential care to children, diagnosed with mental retardation and/or developmental disabilities as respite for the regular caregivers. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306447347 | Tamara Lynn Hershberger | Respite Care | 2291 Stahl Rd, Coventry Township, OH 44319-1321 | 2020-11-05 |
| 1639770274 | The Genesis Program | Respite Care | 1104 Johnston St, Akron, OH 44305-2414 | 2020-11-02 |
| 1649870379 | Jeanne Watson | Respite Care | 254 S Oval Dr, Chardon, OH 44024-1462 | 2020-10-30 |
| 1164021796 | Vida Lynn Martin | Respite Care | 5969 Us Highway 6, Rome, OH 44085-9672 | 2020-10-24 |
| 1508465527 | Mercer Residential Services | Respite Care | 420 S Sugar St, Celina, OH 45822-2431 | 2020-10-21 |
| 1386242121 | Brian Francis Chutes | Respite Care | 110 Harmon Ct, Lagrange, OH 44050-9776 | 2020-10-14 |
| 1750989794 | Sharon Kay Skeriotis | Respite Care | 2285 Briner Ave, Akron, OH 44305-2140 | 2020-10-12 |
| 1437757671 | Janice Marie Shipman | Respite Care | 15103 S State Ave, Middlefield, OH 44062-9467 | 2020-10-10 |
| 1144827494 | Ashley Brzozowski | Respite Care | 12310 Zrolka Dr, Huntsburg, OH 44046-9788 | 2020-10-08 |
| 1649877168 | Kim M. Bolton | Respite Care | 3666 W 159th St, Cleveland, OH 44111-5706 | 2020-10-07 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.