Wood Lane Residential Services, Inc.

NPI #1215029525 in Portage, Ohio

Provider Information

NPI Number: 1215029525
Entity Type: Organization
Organization Name: Wood Lane Residential Services, Inc.
Primary Specialty: Respite Care - Respite Care, Intellectual and/or Developmental Disabilities, Child
Enumeration Date: Sep 28, 2006
Last Updated: Jul 21, 2022

Practice Location

Address: 349 W MAIN ST.
City: Portage
State: Ohio
ZIP Code: 43451
Phone: (419) 353-9577

Authorized Official

Name: JESSICA BLAKELY
Title: CHIEF EXECUTIVE OFFICER
Phone: (419) 353-9577

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320600000X
Respite Care - Respite Care, Intellectual and/or Developmental Disabilities, Child — Respite Care, Intellectual and/or Developmental Disabilities, Child	385HR2060X	Primary

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