Provider Demographics
NPI:1538671110
Name:HOMECARECHAMPS LLC
Entity Type:Organization
Organization Name:HOMECARECHAMPS LLC
Other - Org Name:HOMECARECHAMPS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:O
Authorized Official - Last Name:UKPEDINJAGBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-522-5977
Mailing Address - Street 1:1005 S TELSHOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4879
Mailing Address - Country:US
Mailing Address - Phone:575-556-9302
Mailing Address - Fax:
Practice Address - Street 1:1005 S TELSHOR BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4879
Practice Address - Country:US
Practice Address - Phone:575-556-9302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care