INDIAN TRAILS CAMP, INC. (NPI# 1629381868) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629381868 |
| Entity Type | Organization |
| Organization Name | INDIAN TRAILS CAMP, INC. |
| Practice Address |
O-1859 Lake Michigan Dr Nw Grand Rapids MI 49534-9578 |
| Practice Telephone | 6166775251 |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2010-07-16 |
| Authorized Official Name | TIM HILEMAN (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 6166775251 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 385HR2050X |
Respite Care Specialization: Respite Care Camp |
CR700200614 | MI | Respite Care Facility |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972847184 | Indian Trails Camp, Inc. | Day Training, Developmentally Disabled Services | O-1859 Lake Michigan Dr. Nw, Grand Rapids, MI 49534 | 2012-11-15 |
| Street Address |
O-1859 LAKE MICHIGAN DR NW |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49534-9578 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982009387 | Michael Fischer | Psychologist | O-1859 Lake Michigan Dr Nw, Grand Rapids, MI 49534-9578 | 2014-10-28 |
| 1063817583 | Quinton Zamarripa | Psychologist | O-1859 Lake Michigan Dr Nw, Grand Rapids, MI 49534-9578 | 2014-10-27 |
| 1699170126 | Anne Hill | Psychologist | O-1859 Lake Michigan Dr Nw, Grand Rapids, MI 49534-9578 | 2014-10-27 |
| 1730584251 | Jordan Koenig | Psychologist | O-1859 Lake Michigan Dr Nw, Grand Rapids, MI 49534-9578 | 2014-10-27 |
| 1619372133 | Kaitlyn Zandbergen | Psychologist | O-1859 Lake Michigan Dr Nw, Grand Rapids, MI 49534-9578 | 2014-10-27 |
| 1780089391 | Heather Hines | Psychologist | O-1859 Lake Michigan Dr Nw, Grand Rapids, MI 49534-9578 | 2014-10-24 |
| 1396140919 | Dan Gautz | Psychologist | O-1859 Lake Michigan Dr Nw, Grand Rapids, MI 49534-9578 | 2014-10-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336792324 | Heather Duthler | Social Worker | 648 Kinney Ave Nw, Grand Rapids, MI 49534 | 2019-07-19 |
| 1114473550 | Tari Kruzel | Registered Nurse | 12955 3rd Ave Nw, Grand Rapids, MI 49534 | 2016-08-26 |
| 1972847184 | Indian Trails Camp, Inc. | Day Training, Developmentally Disabled Services | O-1859 Lake Michigan Dr. Nw, Grand Rapids, MI 49534 | 2012-11-15 |
| 1871743815 | Michael Robert Anderson Jr. | Chiropractor | 0-705 Tallmadge Woods Dr. Nw, Suite A, Grand Rapids, MI 49534 | 2008-09-26 |
| 1750459285 | Rick David Saier | Internal Medicine | 1175 Wilson Ave, Walker, MI 49534 | 2006-12-01 |
| 1154414886 | Edward D Young Dds PC | Dentist | 4310 Leonard Nw, Grand Rapids, MI 49534 | 2006-10-02 |
| 1558461756 | Sandra Staublin | Pediatrics | 4288 3 Mile Road, Walker, MI 49534 | 2006-09-25 |
| 1700986999 | Belinda Chou | Pediatrics | 4288 Three Mile Road, Walker, MI 49534 | 2006-09-25 |
| 1639196603 | David Robert Felton | Chiropractor | 4110 Lake Michigan Dr Nw, Grand Rapids, MI 49534 | 2006-07-16 |
| 1952349235 | Chiropractic Plus, P.C. | Chiropractor | 0 699 Tallmadge Wds Nw, Suite B, Grand Rapids, MI 49534 | 2006-06-02 |
| Find all providers in zip 49534 | ||||
| Taxonomy Code | 385HR2050X |
| Grouping | Respite Care Facility |
| Classification | Respite Care |
| Specialization | Respite Care Camp |
| A camping facility that provides specialized respite care to individuals requiring enhanced services to enable them to remain in the community, (e.g., those with developmental delays, mental retardation, mental/behavioral disorders). The staff must have training in working with the target populations and dealing with emergency situations which might be related to or exacerbate the individual's condition. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477179430 | Emily L Lourim | Respite Care | 1850 Kristin Dr, Troy, MI 48084-1451 | 2020-06-24 |
| 1083127880 | The Arc Shiawassee County Inc | Respite Care | 1905 West M-21, Owosso, MI 48867 | 2017-11-15 |
| 1891221842 | Allegan County 4-h Clubs | Respite Care | 39000 1st Ave, Bloomingdale, MI 49026-9743 | 2017-05-11 |
| 1487180493 | Ymca Camp Manitou-lin | Respite Care | 1095 N Briggs Rd, Middleville, MI 49333-9700 | 2017-05-11 |
| 1942736095 | Pine Ridge Bible Camp & Conference Center, Inc. | Respite Care | 8415 17 Mile Rd Ne, Cedar Springs, MI 49319-9220 | 2017-05-11 |
| 1548639420 | Charter Township of Canton | Respite Care | 46000 Summit Pkwy, Canton, MI 48188-3268 | 2015-09-21 |
| 1194093500 | Alhambra St. Francis Camp On The Lake | Respite Care | 10120 Murrey Rd, Jerome, MI 49249-9534 | 2011-12-13 |
| 1104124759 | Care Adult Day Care Inc. | Respite Care | 31521 W Stonewood Ct, Farmington Hills, MI 48334-2547 | 2011-03-07 |
| 1972817351 | The Fowler Center | Respite Care | 2315 Harmon Lake Rd, Mayville, MI 48744-9737 | 2010-07-28 |
| 1891008991 | Camp Grace Bentley | Respite Care | 1877 Maryland Blvd, Birmingham, MI 48009-4119 | 2010-07-17 |
| Find all providers with the same taxonomy | ||||
| City | GRAND RAPIDS |
| Zip Code | 49534 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.