Provider Demographics
NPI:1134368335
Name:CAMP COURAGEOUS, INC.
Entity type:Organization
Organization Name:CAMP COURAGEOUS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEISSLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-875-6828
Mailing Address - Street 1:12701 WATERVILLE SWANTON RD
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43571-9551
Mailing Address - Country:US
Mailing Address - Phone:419-875-6828
Mailing Address - Fax:419-872-5598
Practice Address - Street 1:12701 WATERVILLE SWANTON RD
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:OH
Practice Address - Zip Code:43571-9551
Practice Address - Country:US
Practice Address - Phone:419-875-6828
Practice Address - Fax:419-872-5598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2050XRespite Care FacilityRespite CareRespite Care Camp
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2400306Medicaid
OH4801316OtherODMRDD CONTRACT #