# CHAMPION COMMUNITY PARTNERS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922989144
- **Authorized official:** TRACEY WALLACE (VP OPS)
- **Authorized official phone:** (631) 696-4357

## Contact information

- **Practice address:** 5100 SUNRISE HWY, MASSAPEQUA PARK, NY 11762-2935
- **Practice address phone:** (631) 696-4357
- **Mailing address:** 1377 MOTOR PKWY STE 102, ISLANDIA, NY 11749-5249

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 09/12/2025
- **Last updated:** 09/12/2025