Individual provider · Type 1 NPI
John C. Blake
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Oshkosh, WI
Practice location
50 Pearl Ave Ste 102
Oshkosh, WI 54901-4811
Fax (866) 496-2680
Mailing address
2844 Montclair Pl
Oshkosh, WI 54904-8944
Other practice locations
- 2323 Lake Club Dr Ste 301, Columbus, OH 43232-3198 · (614) 456-4999
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary | 320900000X | 0017165 (WI) |
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
Other intellectual and/or developmental disabilities community based residential treatment facility providers in Oshkosh
About NPI 1134924475
John C. Blake's National Provider Identifier is 1134924475, issued on Feb 19, 2025. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in Oshkosh, WI. The record was last updated on Feb 19, 2025.