NPIMap

Organization Active NPI

Indian Trails Camp, Inc.

  • Respite Care
  • Grand Rapids, MI
National Provider Identifier
1972847184
Registry record updated Nov 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Respite CareTaxonomy code 385H00000X
License
SR700200220 Issued in MI
Legal business name
INDIAN TRAILS CAMP, INC.
Practice address
O-1859 Lake Michigan Dr. NW
Grand Rapids, MI 49534
Phone
(616) 677-5251
Fax
(616) 677-2955
NPI assigned
Nov 15, 2012
Last updated
Nov 15, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Timothy Hileman
Title
Executive Director
Phone
(616) 677-5251

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X
Respite Care 385H00000X SR700200220 MI Primary
Respite Care 385H00000X AC700200613 MI

Addresses

Primary practice location

O-1859 Lake Michigan Dr. NW
Grand Rapids, MI 49534

Mailing address

PO Box 97
Grandville, MI 49468
Phone (616) 677-5251

National Provider Directory

National Provider Directory
Tax ID family
Indian Trails Camp Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

O-1859 Lake Michigan Dr NW
Grand Rapids, MI 49534
Phone (616) 677-5251

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352937600000",
    "number": "1972847184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 97",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "49468",
            "telephone_number": "616-677-5251",
            "fax_number": "616-677-2955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "O-1859 LAKE MICHIGAN DR. NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49534",
            "telephone_number": "616-677-5251",
            "fax_number": "616-677-2955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN TRAILS CAMP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-15",
        "last_updated": "2012-11-15",
        "status": "A",
        "authorized_official_last_name": "HILEMAN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "616-677-5251",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "MI",
            "license": "SR700200220",
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "MI",
            "license": "AC700200613",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.