Provider Demographics
NPI:1114594132
Name:CHAMPION, LACHELLE
Entity Type:Individual
Prefix:
First Name:LACHELLE
Middle Name:
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 ROSEMARY AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-5245
Mailing Address - Country:US
Mailing Address - Phone:937-248-8915
Mailing Address - Fax:937-949-3417
Practice Address - Street 1:4520 ROSEMARY AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-5245
Practice Address - Country:US
Practice Address - Phone:937-248-8915
Practice Address - Fax:937-949-3417
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000000OtherNONE