Individual
JOY CHAMPAGNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
303 MOUNT SYLVAN ST, LINDALE, TX 75771-6235
(903) 882-8337
(903) 882-1627
Mailing address
PO BOX 1749, LINDALE, TX 75771-1749
(903) 882-8337
(903) 882-1627
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
117825
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003687
PROVIDER NUMBER
TX
Enumeration date
11/30/2006
Last updated
07/08/2007
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