Provider Demographics
NPI:1528547973
Name:UNITED CHURCH CAMPS, INC.
Entity Type:Organization
Organization Name:UNITED CHURCH CAMPS, INC.
Other - Org Name:PILGRIM CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-479-8255
Mailing Address - Street 1:1487 MOON BEACH LN
Mailing Address - Street 2:
Mailing Address - City:SAINT GERMAIN
Mailing Address - State:WI
Mailing Address - Zip Code:54558-9259
Mailing Address - Country:US
Mailing Address - Phone:715-479-8255
Mailing Address - Fax:
Practice Address - Street 1:1487 MOON BEACH LN
Practice Address - Street 2:
Practice Address - City:SAINT GERMAIN
Practice Address - State:WI
Practice Address - Zip Code:54558-9259
Practice Address - Country:US
Practice Address - Phone:715-479-8255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2050XRespite Care FacilityRespite CareRespite Care Camp