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General NPI Number Information
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NPI Number | 1487239240
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Entity Type | Organization
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Legal Business Name | CHAMPIONS OF TOMORROW INC
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Dates
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Enumeration Date | 03/13/2021
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 6145 YORKSHIRE RD
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City | DETROIT
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State | MI
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Zip | 48224-3827
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Country | US
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Telephone | 313-799-2311
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Fax | 888-201-7887
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Provider Business Mailing Address
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Address Line | 19001 E 8 MILE RD STE 103
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City | EASTPOINTE
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State | MI
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Zip | 48021-3247
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Country | US
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Telephone | 313-598-7078
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Fax | 888-201-7887
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SHERITA JOHNSON
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Credential |
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Telephone | 313-598-7078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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Taxonomy #5
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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