Provider Demographics
NPI:1659157410
Name:CAMPUS ACADEMY
Entity Type:Organization
Organization Name:CAMPUS ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER ADAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-760-1230
Mailing Address - Street 1:675 E 400 N APT A
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-5880
Mailing Address - Country:US
Mailing Address - Phone:435-265-4245
Mailing Address - Fax:
Practice Address - Street 1:675 E 400 N APT A
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-5880
Practice Address - Country:US
Practice Address - Phone:435-265-4245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health