Healthcare Provider Details

I. General information

NPI: 1104763168
Provider Name (Legal Business Name): ALL STAR CAMP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29685 TAWAS ST
MADISON HEIGHTS MI
48071-5425
US

IV. Provider business mailing address

2360 PEBBLE CREEK DR
OAKLAND MI
48363-2228
US

V. Phone/Fax

Practice location:
  • Phone: 248-990-1508
  • Fax:
Mailing address:
  • Phone: 248-990-1508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State

VIII. Authorized Official

Name: KAREN KMIECIK
Title or Position: DIRECTOR
Credential:
Phone: 248-990-1508