Healthcare Provider Details

I. General information

NPI: 1164556841
Provider Name (Legal Business Name): CAMPAGNA ACADEMY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
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:
Mailing address:
  • Phone: 219-322-8614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. BRUCE HILLMAN
Title or Position: CEO
Credential:
Phone: 219-322-8614