Provider Demographics
NPI:1548757891
Name:CHAMPION HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:CHAMPION HEALTH SERVICES, INC.
Other - Org Name:CHAMPION RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-467-7679
Mailing Address - Street 1:5481 COMMERCIAL DR STE C
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-1259
Mailing Address - Country:US
Mailing Address - Phone:855-699-2221
Mailing Address - Fax:877-735-4866
Practice Address - Street 1:5481 COMMERCIAL DR STE C
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-1259
Practice Address - Country:US
Practice Address - Phone:855-699-2221
Practice Address - Fax:877-735-4866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY511793336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB294710Medicaid