Provider Demographics
NPI:1942576301
Name:GLOBAL CHAMPION'S FOR LIFE PERSONAL CARE INCORPORATED
Entity Type:Organization
Organization Name:GLOBAL CHAMPION'S FOR LIFE PERSONAL CARE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SCHANTEL
Authorized Official - Middle Name:LETICIA
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-797-1600
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 ROAD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090
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:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02762050305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization