Organization
INDIAN TRAILS CAMP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIM HILEMAN (EXECUTIVE DIRECTOR)
(616) 677-5251
Entity
Organization
Contact information
Practice address
O-1859 LAKE MICHIGAN DR NW, GRAND RAPIDS, MI 49534-9578
(616) 677-5251
Mailing address
O-1859 LAKE MICHIGAN DR NW, GRAND RAPIDS, MI 49534-9578
Taxonomy
Speciality
Code
Description
License number
State
385HR2050X
Respite Care Camp
Primary
CR700200614
MI
Other
Enumeration date
07/16/2010
Last updated
07/16/2010
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