IndividualActive
Shari Blackburn
NPI 1174850002 · Intellectual and/or Developmental Disabilities Residential Treatment Facility · Fort Gratiot, MI
Provider details
- NPI number
- 1174850002
- Entity type
- Individual
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityResidential Treatment Facilities
- Sex
- Female
- Sole proprietor
- Yes
- License
- AF740302832 (MI)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityPrimary320600000XLicense AF740302832 (MI)
Residential Treatment Facilities
Profile Score
Detailed profile(84/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
16 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
3399 Oxbow Dr
Fort Gratiot, MI 48059-4124
Phone: (810) 990-8134
Street-level locationGet directions
Mailing address
3399 Oxbow Dr
Fort Gratiot, MI 48059-4124
Registry dates
- Enumerated
- 2009-11-13
- Last updated
- 2009-11-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.