Provider Demographics
NPI:1508142274
Name:CHAMPION CAREGIVERS, INC.
Entity Type:Organization
Organization Name:CHAMPION CAREGIVERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:KIMBERLY
Authorized Official - Last Name:CHAMPION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-347-0440
Mailing Address - Street 1:1801 CLINT MOORE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2752
Mailing Address - Country:US
Mailing Address - Phone:561-347-0440
Mailing Address - Fax:
Practice Address - Street 1:1801 CLINT MOORE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2752
Practice Address - Country:US
Practice Address - Phone:561-347-0440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211446251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health