Provider Demographics
NPI:1982723326
Name:MY CAMP INC
Entity Type:Organization
Organization Name:MY CAMP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR QMRP
Authorized Official - Prefix:MISS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HABECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-788-2345
Mailing Address - Street 1:1622 HIGHWAY A
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63783-9115
Mailing Address - Country:US
Mailing Address - Phone:573-788-2345
Mailing Address - Fax:573-788-2498
Practice Address - Street 1:1622 HIGHWAY A
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:MO
Practice Address - Zip Code:63783-9115
Practice Address - Country:US
Practice Address - Phone:573-788-2345
Practice Address - Fax:573-788-2498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1366-8688251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services