Provider Demographics
NPI:1376941005
Name:CHAMPION HOME HEALTHCARE INC
Entity Type:Organization
Organization Name:CHAMPION HOME HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAQUELINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-327-7800
Mailing Address - Street 1:PO BOX 20791
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-0791
Mailing Address - Country:US
Mailing Address - Phone:248-327-7800
Mailing Address - Fax:248-327-7822
Practice Address - Street 1:16250 NORTHLAND DR
Practice Address - Street 2:STE 368
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5205
Practice Address - Country:US
Practice Address - Phone:248-327-7800
Practice Address - Fax:248-327-7822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicaid