Provider Demographics
NPI:1154835064
Name:CHAMPIONS INTEGRATED BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:CHAMPIONS INTEGRATED BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TARVARES
Authorized Official - Middle Name:JERMAINE
Authorized Official - Last Name:DOWNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-242-3621
Mailing Address - Street 1:PO BOX 332
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33845-0332
Mailing Address - Country:US
Mailing Address - Phone:863-242-3621
Mailing Address - Fax:
Practice Address - Street 1:1216 TEMPLE CIR
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-6157
Practice Address - Country:US
Practice Address - Phone:863-242-3621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-30
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care