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General NPI Number Information
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NPI Number | 1134368335
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Entity Type | Organization
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Legal Business Name | CAMP COURAGEOUS, INC.
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 03/04/2009
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Provider Practice Location Address
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Address Line | 12701 WATERVILLE SWANTON RD
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City | WHITEHOUSE
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State | OH
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Zip | 43571-9551
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Country | US
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Telephone | 419-875-6828
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Fax | 419-872-5598
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Provider Business Mailing Address
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Address Line | 12701 WATERVILLE SWANTON RD
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City | WHITEHOUSE
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State | OH
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Zip | 43571-9551
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Country | US
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Telephone | 419-875-6828
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Fax | 419-872-5598
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. STEVEN KEISSLING
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Credential |
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Telephone | 419-875-6828
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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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