Healthcare Provider Details

I. General information

NPI: 1447283270
Provider Name (Legal Business Name): CHAMPION CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 MARKET ST
LAREDO TX
78040
US

IV. Provider business mailing address

1419 MARKET ST
LAREDO TX
78040-8841
US

V. Phone/Fax

Practice location:
  • Phone: 956-712-2156
  • Fax: 956-727-7861
Mailing address:
  • Phone: 956-712-2156
  • Fax: 956-727-7861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number004883
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: YOLINDA TREVINO
Title or Position: DIRECTOR/CEO/CFO
Credential: RN
Phone: 956-718-2777