# CHAMPAIGN RESIDENTIAL SERVICES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CHAMPAIGN RESIDENTIAL SERVICES, INC.
- **Other names:** High Street
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1437397031
- **Legal business name:** CHAMPAIGN RESIDENTIAL SERVICES, INC.
- **Authorized official:** MR. THAN JOHNSON (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (937) 653-1320

## Contact information

- **Practice address:** 809 SOUTH HIGH STREET, URBANA, OH 43078
- **Practice address phone:** (937) 653-1320
- **Practice address fax:** (937) 653-1321
- **Mailing address:** P.O. BOX 29, URBANA, OH 43078-0029
- **Mailing address phone:** (937) 653-1320
- **Mailing address fax:** (937) 653-1321

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 02/04/2009
- **Last updated:** 02/04/2009