Provider Demographics
NPI:1245276906
Name:WILDERNESS WAY CAMP SCHOOL INC
Entity type:Organization
Organization Name:WILDERNESS WAY CAMP SCHOOL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:EDGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-972-0611
Mailing Address - Street 1:175 CAMP SCHOOL LN
Mailing Address - Street 2:
Mailing Address - City:FAIR PLAY
Mailing Address - State:SC
Mailing Address - Zip Code:29643
Mailing Address - Country:US
Mailing Address - Phone:864-972-0611
Mailing Address - Fax:864-972-2045
Practice Address - Street 1:175 CAMP SCHOOL LN
Practice Address - Street 2:
Practice Address - City:FAIR PLAY
Practice Address - State:SC
Practice Address - Zip Code:29643
Practice Address - Country:US
Practice Address - Phone:864-972-0611
Practice Address - Fax:864-972-2045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty