# INDIAN TRAILS CAMP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972847184
- **Authorized official:** MR. TIMOTHY HILEMAN (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (616) 677-5251

## Contact information

- **Practice address:** O-1859 LAKE MICHIGAN DR. NW, GRAND RAPIDS, MI 49534
- **Practice address phone:** (616) 677-5251
- **Practice address fax:** (616) 677-2955
- **Mailing address:** PO BOX 97, GRANDVILLE, MI 49468
- **Mailing address phone:** (616) 677-5251
- **Mailing address fax:** (616) 677-2955

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251C00000X | Developmentally Disabled Services Day Training Agency | — | NULL | — |
| 385H00000X | Respite Care | AC700200613 | MI | — |
| 385H00000X | Respite Care | SR700200220 | MI | Yes |

## Other

- **Enumeration date:** 11/15/2012
- **Last updated:** 11/15/2012