Healthcare Provider Details

I. General information

NPI: 1760357248
Provider Name (Legal Business Name): CHAMPION HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W 9TH AVE STE 209
ESCONDIDO CA
92025-5053
US

IV. Provider business mailing address

350 W 9TH AVE STE 209
ESCONDIDO CA
92025-5053
US

V. Phone/Fax

Practice location:
  • Phone: 760-975-3409
  • Fax: 760-975-3471
Mailing address:
  • Phone: 760-975-3409
  • Fax: 760-975-3471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State

VIII. Authorized Official

Name: RENE GAMEZ
Title or Position: OWNER CEO
Credential:
Phone: 619-845-6287