Healthcare Provider Details

I. General information

NPI: 1215713177
Provider Name (Legal Business Name): TYEISHA CHAMPION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/06/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 SUMMIT RD STE G20
CINCINNATI OH
45237-2800
US

IV. Provider business mailing address

1821 SUMMIT RD STE G20
CINCINNATI OH
45237-2800
US

V. Phone/Fax

Practice location:
  • Phone: 513-918-6531
  • Fax:
Mailing address:
  • Phone: 513-918-6531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number401598401213
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: