Provider Demographics
NPI:1609140920
Name:A CHAMPION HOME & COMMUNITY SERVICES
Entity Type:Organization
Organization Name:A CHAMPION HOME & COMMUNITY SERVICES
Other - Org Name:A CHAMPION HOME & COMMUNITY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-463-3054
Mailing Address - Street 1:119 EXECUTIVE WAY STE 303
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2341
Mailing Address - Country:US
Mailing Address - Phone:469-463-3054
Mailing Address - Fax:214-306-6035
Practice Address - Street 1:119 EXECUTIVE WAY STE 303
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2341
Practice Address - Country:US
Practice Address - Phone:469-463-3054
Practice Address - Fax:214-306-6035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency