Provider Demographics
NPI:1942920772
Name:CHAMPION LEARNING CENTER LLC
Entity Type:Organization
Organization Name:CHAMPION LEARNING CENTER LLC
Other - Org Name:CHAMPION AUTISM THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEEQO
Authorized Official - Middle Name:
Authorized Official - Last Name:ABI
Authorized Official - Suffix:
Authorized Official - Credentials:CDA
Authorized Official - Phone:612-267-6293
Mailing Address - Street 1:3355 HIAWATHA AVE S, STE 160
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2444
Mailing Address - Country:US
Mailing Address - Phone:612-263-6293
Mailing Address - Fax:
Practice Address - Street 1:3355 HIAWATHA AVE S, STE 160
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-2444
Practice Address - Country:US
Practice Address - Phone:612-263-6293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health