Provider Demographics
NPI:1467976100
Name:CHAMPIONS FOREVER, LLC
Entity Type:Organization
Organization Name:CHAMPIONS FOREVER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARTESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEAL -WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-594-9545
Mailing Address - Street 1:3707 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3959
Mailing Address - Country:US
Mailing Address - Phone:248-594-9545
Mailing Address - Fax:
Practice Address - Street 1:25750 LAHSER RD STE 210
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-5809
Practice Address - Country:US
Practice Address - Phone:248-415-2526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services