MEDICARE: CHAMPAIGN RESIDENTIAL SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility		OH

General Provider Information

NPI Number	:	1164894150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAMPAIGN RESIDENTIAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	1150 SCIOTO ST
Second Line	:	PO BOX 29
City	:	URBANA
State	:	OH
Zip	:	43078-2289
Country	:	US
Telephone Number	:	937-653-1320
Fax Number	:	937-653-1321

Provider Business Practice Location Address
First Line	:	710 S MAIN ST
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-9260
Country	:	US
Telephone Number	:	937-653-1320
Fax Number	:	937-653-1321

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SCOTT A DELONG
Credential	:
Telephone Number	:	937-653-1320

Provider Enumeration Date	:	10/29/2015
Last Update Date	:	10/29/2015

Similar Medicare Providers

1245631688 — MRS. BRITTANY DEY HEIL SLP
Practice Location Address:

3582 TOOMER KILN CIR
MOUNT PLEASANT, SC
29466-9260

Practice Phone: 843-388-5897
Practice Fax:

1184407967 — BRENDA ANNETTE BOWERS LPN
Practice Location Address:

106 EAST GAMBIER STREET
MOUNT VERNON, OH
43050-3510

Practice Phone: 740-397-2660
Practice Fax: 740-392-3613

1912865536 — LINDSEY JOHNSON
Practice Location Address:

8402 BLACKJACK RD
MOUNT VERNON, OH
43050-9193

Practice Phone: 740-397-0442
Practice Fax:

1912864174 — PATTY ANN SKEENS
Practice Location Address:

5218 JOHNSTOWN RD
MOUNT VERNON, OH
43050-9353

Practice Phone: 740-751-1743
Practice Fax:

1528927662 — ALEXIS MCMAHAN
Practice Location Address:

8402 BLACKJACK RD
MOUNT VERNON, OH
43050-9193

Practice Phone: 740-397-0442
Practice Fax:

1144261652 — RON T MARTINSON MD
Practice Location Address:

1330 COSHOCTON AVE
MOUNT VERNON, OH
43050-1440

Practice Phone: 740-326-3521
Practice Fax: 740-326-3522

Directions to “CHAMPAIGN RESIDENTIAL SERVICES, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.