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General NPI Number Information
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NPI Number | 1104763168
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Entity Type | Organization
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Legal Business Name | ALL STAR CAMP
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Dates
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Enumeration Date | 04/29/2026
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Last Update Date | 04/29/2026
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Provider Practice Location Address
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Address Line | 29685 TAWAS ST
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-5425
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Country | US
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Telephone | 248-990-1508
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Fax |
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Provider Business Mailing Address
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Address Line | 2360 PEBBLE CREEK DR
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City | OAKLAND
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State | MI
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Zip | 48363-2228
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Country | US
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Telephone | 248-990-1508
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | KAREN KMIECIK
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Credential |
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Telephone | 248-990-1508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2050X
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Taxonomy Name | Respite Care Camp
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License Number |
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License Number State |
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