Provider Demographics
NPI:1396387874
Name:CAMP ALBRECHT ACRES OF THE MIDWEST, INC.
Entity Type:Organization
Organization Name:CAMP ALBRECHT ACRES OF THE MIDWEST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:BERTJAN
Authorized Official - Last Name:VELTSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-552-1771
Mailing Address - Street 1:PO BOX 50
Mailing Address - Street 2:
Mailing Address - City:SHERRILL
Mailing Address - State:IA
Mailing Address - Zip Code:52073-0050
Mailing Address - Country:US
Mailing Address - Phone:563-552-1171
Mailing Address - Fax:563-552-2732
Practice Address - Street 1:14837 SHERRILL RD
Practice Address - Street 2:
Practice Address - City:SHERRILL
Practice Address - State:IA
Practice Address - Zip Code:52073-9564
Practice Address - Country:US
Practice Address - Phone:563-552-1771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2050XRespite Care FacilityRespite CareRespite Care Camp
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA000278903Medicaid