Healthcare Provider Details

I. General information

NPI: 1689958365
Provider Name (Legal Business Name): CAMPAGNA ACADEMY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7403 CLINE AVE
SCHERERVILLE IN
46375-2645
US

IV. Provider business mailing address

7403 CLINE AVE
SCHERERVILLE IN
46375-2645
US

V. Phone/Fax

Practice location:
  • Phone: 219-322-8614
  • Fax: 219-322-8436
Mailing address:
  • Phone: 219-322-8614
  • Fax: 219-322-8436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: SCOTT STEVENS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 219-322-8614