Provider Demographics
NPI:1750731204
Name:CHAMP SERVICES INC
Entity type:Organization
Organization Name:CHAMP SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KAHL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:917-975-1968
Mailing Address - Street 1:176 ASHWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4900
Mailing Address - Country:US
Mailing Address - Phone:917-975-1968
Mailing Address - Fax:718-494-1806
Practice Address - Street 1:176 ASHWORTH AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4900
Practice Address - Country:US
Practice Address - Phone:917-975-1968
Practice Address - Fax:718-494-1806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency