Organization
CAMP COURAGEOUS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN KEISSLING (DIRECTOR)
(419) 875-6828
Entity
Organization
Contact information
Practice address
12701 WATERVILLE SWANTON RD, WHITEHOUSE, OH 43571-9551
(419) 875-6828
(419) 872-5598
Mailing address
12701 WATERVILLE SWANTON RD, WHITEHOUSE, OH 43571-9551
(419) 875-6828
(419) 872-5598
Taxonomy
Speciality
Code
Description
License number
State
385HR2050X
Respite Care Camp
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2400306
—
OH
01
—
4801316
ODMRDD CONTRACT #
OH
Enumeration date
02/11/2009
Last updated
03/04/2009
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