Healthcare Provider Details

I. General information

NPI: 1407213630
Provider Name (Legal Business Name): CHAMPION HOMECARE & FINANCIAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 06/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 MAIN ST
BROCKTON MA
02301-6024
US

IV. Provider business mailing address

673 N MAIN ST
BROCKTON MA
02301-2407
US

V. Phone/Fax

Practice location:
  • Phone: 508-857-4015
  • Fax: 508-256-0406
Mailing address:
  • Phone: 508-857-4015
  • Fax: 508-256-0406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberT8A7
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: DJOVANY PIERRE
Title or Position: ADMINISTRATOR
Credential:
Phone: 508-857-4015