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General NPI Number Information
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NPI Number | 1497266365
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Entity Type | Organization
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Legal Business Name | CHAMPION FAMILY HEALTHCARE SERVICES, LLC
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Dates
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Enumeration Date | 10/19/2017
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Last Update Date | 10/23/2017
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Provider Practice Location Address
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Address Line | 1410 MILLGATE DR STE A
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City | WINSTON SALEM
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State | NC
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Zip | 27103-1336
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Country | US
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Telephone | 336-608-4612
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Fax | 336-608-4739
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Provider Business Mailing Address
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Address Line | 1410 MILLGATE DR STE A
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City | WINSTON SALEM
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State | NC
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Zip | 27103-1336
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Country | US
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Telephone | 336-608-4612
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Fax | 336-608-4739
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ANTOINETTE LOIS VAN-RIEL
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Credential |
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Telephone | 336-608-4612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HC1170
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | HC1170
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License Number State | NC
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