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General NPI Number Information
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NPI Number | 1194480087
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Entity Type | Organization
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Legal Business Name | LIFE CHAMPIONS, LLC
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 2007 LYNN RD
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City | GREENSBORO
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State | NC
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Zip | 27405-6519
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Country | US
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Telephone | 336-601-1967
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Fax |
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Provider Business Mailing Address
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Address Line | 2007 LYNN RD
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City | GREENSBORO
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State | NC
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Zip | 27405-6519
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Country | US
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Telephone | 336-601-1967
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ARNOLD LEROY GAINES JR.
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Credential |
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Telephone | 336-601-1967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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