Organization
CHAMPION FAMILY CARE HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHY CHAMPION (OWNER)
(704) 434-7727
Entity
Organization
Contact information
Practice address
127 LUCAS LN, MOORESBORO, NC 28114-6799
(704) 434-7727
Mailing address
127 LUCAS LN, MOORESBORO, NC 28114-6799
(704) 494-7727
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805153
—
NC
Enumeration date
07/26/2007
Last updated
07/26/2007
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