Provider Demographics
NPI:1013056431
Name:CHAMPAGNE HOUSE
Entity Type:Organization
Organization Name:CHAMPAGNE HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMPAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-882-8337
Mailing Address - Street 1:PO BOX 1749
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-1749
Mailing Address - Country:US
Mailing Address - Phone:903-882-8337
Mailing Address - Fax:903-882-1627
Practice Address - Street 1:303 MOUNT SYLVAN ST
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-6235
Practice Address - Country:US
Practice Address - Phone:903-882-8337
Practice Address - Fax:903-882-1627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities