MEDICARE: CHAMPION LIFE HOUSE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	251B00000X	Case Management Agency
3	385HR2050X	Respite Care Camp
4	385HR2055X	Child Mental Illness Respite Care
5	101YA0400X	Addiction (Substance Use Disorder) Counselor
6	101YM0800X	Mental Health Counselor
7	104100000X	Social Worker
8	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1982415246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAMPION LIFE HOUSE

Provider Business Mailing Address
First Line	:	4764 FISHBURG RD STE E
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-5456
Country	:	US
Telephone Number	:	317-531-7990
Fax Number	:

Provider Business Practice Location Address
First Line	:	4764 FISHBURG RD STE E
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-5456
Country	:	US
Telephone Number	:	317-531-7990
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LEILA CHAMPION
Credential	:
Telephone Number	:	317-531-7990

Provider Enumeration Date	:	01/16/2025
Last Update Date	:	01/16/2025

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Directions to “CHAMPION LIFE HOUSE ” Practice Location

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