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INDIAN TRAILS CAMP INC. NPI 1629381868


NPI Information

NPI: 1629381868
Provider Name: INDIAN TRAILS CAMP, INC.
Classification: Respite Care - 385HR2050X
Entity Type: Organization

Specialization: Respite Care Camp

CLIA Number: 23D2224841

Address:
O-1859 LAKE MICHIGAN DR NW
GRAND RAPIDS, MI
ZIP 49534
Phone: (616) 677-5251
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INDIAN TRAILS CAMP, INC. is a respite care camp respite care in Grand Rapids, MI. The provider is a camping facility that provides specialized respite care to individuals requiring enhanced services to enable them to remain in the community, (e.g., those with developmental delays, intellectual disabilities, mental/behavioral disorders). The staff must have training in working with the target populations and dealing with emergency situations which might be related to or exacerbate the individual's condition. INDIAN TRAILS CAMP, INC. NPI is 1629381868. The provider is registered as an organization entity type.

The provider's business location address is:

O-1859 LAKE MICHIGAN DR NW
GRAND RAPIDS, MI
ZIP 49534-578
Phone: (616) 677-5251

The provider's authorized official is Tim Hileman .
The authorized official title is Executive Director and has the following contact phone number (616) 677-5251.

The CLIA number assigned to this NPI record is 23D2224841 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/16/2010 and was last updated on 7/16/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1385HR2050XRespite CareRespite Care CampCR700200614MICHIGANYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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