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General NPI Number Information
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NPI Number | 1619288008
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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 | 06/30/2010
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 2717 SAWGRASS CT
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City | WINSTON SALEM
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State | NC
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Zip | 27103-6691
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Country | US
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Telephone | 336-659-2359
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Fax | 336-785-9111
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Provider Business Mailing Address
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Address Line | 2717 SAWGRASS CT
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City | WINSTON SALEM
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State | NC
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Zip | 27103-6691
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Country | US
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Telephone | 336-659-2359
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Fax | 336-785-9111
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. ANTOINETTE LOIS VAN-RIEL
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Credential |
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Telephone | 901-283-4566
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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 | HC4124
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License Number State | NC
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