Provider Demographics
NPI:1720586860
Name:CHAMPIONS FOR HEALING LLC
Entity Type:Organization
Organization Name:CHAMPIONS FOR HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:JINGA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGLESBY-BRIHM
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:305-905-9757
Mailing Address - Street 1:2054 VISTA PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-6742
Mailing Address - Country:US
Mailing Address - Phone:305-905-9757
Mailing Address - Fax:
Practice Address - Street 1:2054 VISTA PKWY STE 400
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-6742
Practice Address - Country:US
Practice Address - Phone:305-905-9757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty