Provider Demographics
NPI:1093690406
Name:KAMPULAND INC
Entity type:Organization
Organization Name:KAMPULAND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-213-3679
Mailing Address - Street 1:750 DERBY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45232-1816
Mailing Address - Country:US
Mailing Address - Phone:513-873-8800
Mailing Address - Fax:
Practice Address - Street 1:750 DERBY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45232-1816
Practice Address - Country:US
Practice Address - Phone:513-873-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No347B00000XTransportation ServicesBus
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1841744386Medicaid
OH1548976285Medicaid
OH1013665645Medicaid