Provider Demographics
NPI:1013232719
Name:CAMPAGNA ACADEMY
Entity Type:Organization
Organization Name:CAMPAGNA ACADEMY
Other - Org Name:CAMPAGNA ACADEMY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF ADMISISONS
Authorized Official - Prefix:MS
Authorized Official - First Name:KAFREN
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, CADACII
Authorized Official - Phone:219-322-8614
Mailing Address - Street 1:7403 CLINE AVE
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2645
Mailing Address - Country:US
Mailing Address - Phone:219-322-8614
Mailing Address - Fax:219-322-8636
Practice Address - Street 1:7403 CLINE AVE
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-2645
Practice Address - Country:US
Practice Address - Phone:219-322-8614
Practice Address - Fax:219-322-8636
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMPAGNA ACADEMY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children