Provider Demographics
NPI:1699042093
Name:CHAMPIONS FOR LIFE PERSONAL CARE FACILITY
Entity Type:Organization
Organization Name:CHAMPIONS FOR LIFE PERSONAL CARE FACILITY
Other - Org Name:SIGNS & WONDERS MINISTRIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED VOCATIONAL NURSE (LVN)
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NAVA
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:832-352-5203
Mailing Address - Street 1:1506 ELK RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-1144
Mailing Address - Country:US
Mailing Address - Phone:832-797-1600
Mailing Address - Fax:
Practice Address - Street 1:1506 ELK RIVER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-1144
Practice Address - Country:US
Practice Address - Phone:832-797-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX187911310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility