Healthcare Provider Details

I. General information

NPI: 1013232719
Provider Name (Legal Business Name): CAMPAGNA ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 04/06/2010
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: 219-322-8636
Mailing address:
  • Phone: 219-322-8614
  • Fax: 219-322-8636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateIN

VIII. Authorized Official

Name: MS. KAFREN ELISE WYATT
Title or Position: DIRECTOR OF ADMISISONS
Credential: MHS, CADACII
Phone: 219-322-8614