Provider Demographics
NPI:1447752944
Name:CHAMPION HOME TRANSITIONS
Entity Type:Organization
Organization Name:CHAMPION HOME TRANSITIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:BONIFAZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-300-2432
Mailing Address - Street 1:1887 ROSS LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-4050
Mailing Address - Country:US
Mailing Address - Phone:720-300-2432
Mailing Address - Fax:
Practice Address - Street 1:1887 ROSS LN
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-4050
Practice Address - Country:US
Practice Address - Phone:720-300-2432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty