Organization
INDIAN TRAILS CAMP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY HILEMAN (EXECUTIVE DIRECTOR)
(616) 677-5251
Entity
Organization
Contact information
Practice address
O-1859 LAKE MICHIGAN DR. NW, GRAND RAPIDS, MI 49534
(616) 677-5251
(616) 677-2955
Mailing address
PO BOX 97, GRANDVILLE, MI 49468
(616) 677-5251
(616) 677-2955
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
385H00000X
Respite Care
AC700200613
MI
385H00000X
Respite Care
Primary
SR700200220
MI
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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