Organization
CHAMPION COMMUNITY PARTNERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY WALLACE (VP OPS)
(631) 696-4357
Entity
Organization
Contact information
Practice address
5100 SUNRISE HWY, MASSAPEQUA PARK, NY 11762-2935
(631) 696-4357
Mailing address
1377 MOTOR PKWY STE 102, ISLANDIA, NY 11749-5249
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/12/2025
Last updated
09/12/2025
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