Healthcare Provider Details

I. General information

NPI: 1134368335
Provider Name (Legal Business Name): CAMP COURAGEOUS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12701 WATERVILLE SWANTON RD
WHITEHOUSE OH
43571-9551
US

IV. Provider business mailing address

12701 WATERVILLE SWANTON RD
WHITEHOUSE OH
43571-9551
US

V. Phone/Fax

Practice location:
  • Phone: 419-875-6828
  • Fax: 419-872-5598
Mailing address:
  • Phone: 419-875-6828
  • Fax: 419-872-5598

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: MR. STEVEN KEISSLING
Title or Position: DIRECTOR
Credential:
Phone: 419-875-6828