Provider Demographics
NPI:1841944196
Name:CHAMPION HEALTHCARE GROUP LLC DBA ROLANDA FORD SOLE MBR
Entity type:Organization
Organization Name:CHAMPION HEALTHCARE GROUP LLC DBA ROLANDA FORD SOLE MBR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKERING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-239-9467
Mailing Address - Street 1:2850 EASTEX FWY # 100
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77703-4645
Mailing Address - Country:US
Mailing Address - Phone:409-347-8989
Mailing Address - Fax:409-347-8979
Practice Address - Street 1:2850 EASTEX FWY # 100
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77703-4645
Practice Address - Country:US
Practice Address - Phone:409-347-8989
Practice Address - Fax:409-347-8979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty