Provider Demographics
NPI:1821166976
Name:CAMP VENTURE
Entity Type:Organization
Organization Name:CAMP VENTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-624-5324
Mailing Address - Street 1:25 SMITH ST
Mailing Address - Street 2:SUITE 512
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 CONVENT RD
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-3106
Practice Address - Country:US
Practice Address - Phone:845-624-5322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00546034Medicaid