Organization
CHAMPAIGN RESIDENTIAL SERVICES, INC.
Active
Parent organization
CHAMPAIGN RESIDENTIAL SERVICES, INC.
Other names
Oakland Street
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHAMPAIGN RESIDENTIAL SERVICES, INC.
Authorized official
MR. THAN JOHNSON (CHIEF EXECUTIVE OFFICER)
(937) 653-1320
Entity
Organization
Contact information
Practice address
400 OAKLAND STREET, URBANA, OH 43078
(937) 653-1321
(937) 653-1321
Mailing address
P.O. BOX 29, URBANA, OH 43078-0029
(937) 653-1320
(937) 653-1321
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0458633
—
OH
Enumeration date
02/05/2009
Last updated
02/05/2009
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