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Organization
CHAMPION FAMILY HEALTHCARE SERVICES, LLC
Active
Organization
CHAMPION FAMILY HEALTHCARE SERVICES, LLC
Active
Parent organization
CHAMPION FAMILY HEALTHCARE SERVICES, LLC
Other names
Keston Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHAMPION FAMILY HEALTHCARE SERVICES, LLC
Authorized official
ANTOINETTE LOIS VAN-RIEL (EXECUTIVE DIRECTOR)
(336) 608-4612
Entity
Organization
Contact information
Practice address
1410 MILLGATE DR STE A, WINSTON SALEM, NC 27103-1336
(336) 608-4612
(336) 608-4739
Mailing address
1410 MILLGATE DR STE A, WINSTON SALEM, NC 27103-1336
(336) 608-4612
(336) 608-4739
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
HC1170
NC
253Z00000X
In Home Supportive Care Agency
Primary
HC1170
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34008537
—
NC
05
—
6600279
—
NC
Enumeration date
10/19/2017
Last updated
10/23/2017
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