Provider Demographics
NPI:1073054730
Name:CHAMPION HOUSE OF CARE
Entity Type:Organization
Organization Name:CHAMPION HOUSE OF CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANETTE
Authorized Official - Middle Name:LOVERN
Authorized Official - Last Name:KINARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-746-8081
Mailing Address - Street 1:5907 BARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-2311
Mailing Address - Country:US
Mailing Address - Phone:704-746-8081
Mailing Address - Fax:980-859-7106
Practice Address - Street 1:5907 BARRINGTON DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-2311
Practice Address - Country:US
Practice Address - Phone:704-746-8081
Practice Address - Fax:980-859-7106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25C00000X251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services