Provider Demographics
NPI:1467784017
Name:CHAMPION SUPPORTS & COMMUNITY SERVICES, INC
Entity Type:Organization
Organization Name:CHAMPION SUPPORTS & COMMUNITY SERVICES, INC
Other - Org Name:CHAMPION SUPPORTS & COMMUNITY SERVICES, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:NEWSOME
Authorized Official - Last Name:GOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-432-8666
Mailing Address - Street 1:3409 N MAYO TRL
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3268
Mailing Address - Country:US
Mailing Address - Phone:606-432-8666
Mailing Address - Fax:606-432-8159
Practice Address - Street 1:3409 N MAYO TRL
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3268
Practice Address - Country:US
Practice Address - Phone:606-432-8666
Practice Address - Fax:606-432-8159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities