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Contact Information

INDIAN TRAILS CAMP, INC.
O-1859 LAKE MICHIGAN DR. NW
GRAND RAPIDS, MI49534
 Phone: 616-677-5251
 Fax: 616-677-2955
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Respite Care

385H00000X
 

Day Training, Developmentally Disabled Services

251C00000X
Indicates primary specialty

NPI Profile & details for INDIAN TRAILS CAMP, INC.

NPI Number 1972847184
LBN Legal business name INDIAN TRAILS CAMP, INC.
Authorized official TIMOTHY HILEMAN - (EXECUTIVE DIRECTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 11/15/2012
Last updated 11/15/2012 - About 14 years ago
Identifiers
MI License # AC700200613
MI License # SR700200220
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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