Provider Demographics
NPI:1255993473
Name:CAMP ZIP OF MICHIGAN
Entity type:Organization
Organization Name:CAMP ZIP OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULLEE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KAZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-405-7041
Mailing Address - Street 1:47554 W HURON RIVER DR
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-4400
Mailing Address - Country:US
Mailing Address - Phone:734-634-9793
Mailing Address - Fax:
Practice Address - Street 1:111 S WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-4644
Practice Address - Country:US
Practice Address - Phone:313-405-7041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care