Provider Demographics
NPI:1235695115
Name:CHAMPIONS FOR NEW YORK, LLC
Entity Type:Organization
Organization Name:CHAMPIONS FOR NEW YORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAAZANIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ASAHGUII
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-942-3923
Mailing Address - Street 1:2039 BLACKROCK AVE APT 2C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-6130
Mailing Address - Country:US
Mailing Address - Phone:646-942-3923
Mailing Address - Fax:
Practice Address - Street 1:2039 BLACKROCK AVE APT 2C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-6130
Practice Address - Country:US
Practice Address - Phone:646-942-3923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management