Provider Demographics
NPI:1891425252
Name:CHAMPION FAMILIES MINISTRIES LLC
Entity Type:Organization
Organization Name:CHAMPION FAMILIES MINISTRIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:936-900-8400
Mailing Address - Street 1:1129 RUSH ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4876
Mailing Address - Country:US
Mailing Address - Phone:936-900-8400
Mailing Address - Fax:
Practice Address - Street 1:1129 RUSH ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-4876
Practice Address - Country:US
Practice Address - Phone:936-900-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)