Provider Demographics
NPI:1124644687
Name:CHAMPION HEALTH CARE, LLC
Entity type:Organization
Organization Name:CHAMPION HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALEXA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:202-743-1775
Mailing Address - Street 1:43923 GLENHAZEL DR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3949
Mailing Address - Country:US
Mailing Address - Phone:202-743-1775
Mailing Address - Fax:
Practice Address - Street 1:770 5TH ST NW APT 1106
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2672
Practice Address - Country:US
Practice Address - Phone:202-743-1775
Practice Address - Fax:202-301-1278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center