Healthcare Provider Details

I. General information

NPI: 1528547973
Provider Name (Legal Business Name): UNITED CHURCH CAMPS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1487 MOON BEACH LN
SAINT GERMAIN WI
54558-9259
US

IV. Provider business mailing address

1487 MOON BEACH LN
SAINT GERMAIN WI
54558-9259
US

V. Phone/Fax

Practice location:
  • Phone: 715-479-8255
  • Fax:
Mailing address:
  • Phone: 715-479-8255
  • 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: ERIC OLSEN
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 715-479-8255