Provider Demographics
NPI:1275768921
Name:CHAMPION HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:CHAMPION HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ZULU
Authorized Official - Middle Name:
Authorized Official - Last Name:NWANKWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-771-4517
Mailing Address - Street 1:4241 KNIGHTSBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-8441
Mailing Address - Country:US
Mailing Address - Phone:919-771-4517
Mailing Address - Fax:919-231-1456
Practice Address - Street 1:4241 KNIGHTSBRIDGE WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-8441
Practice Address - Country:US
Practice Address - Phone:919-771-4517
Practice Address - Fax:919-231-1456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health