Shari Blackburn
Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Fort Gratiot, MI. Individual provider (NPI-1).
NPI number1174850002
StatusActive
Last updated in NPPESNov 13, 2009
Details
- NPI
- 1174850002
- Entity type
- Individual (NPI-1)
- Name
- Shari Blackburn
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Nov 13, 2009
- Last updated
- Nov 13, 2009
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320600000X | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | AF740302832 | MI | Yes |
Practice location
3399 Oxbow DrFort Gratiot, MI 48059-4124
Phone 810-990-8134
Mailing address
3399 Oxbow DrFort Gratiot, MI 48059-4124
Phone 810-990-8134
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