Provider Demographics
NPI:1194480087
Name:LIFE CHAMPIONS, LLC
Entity type:Organization
Organization Name:LIFE CHAMPIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:336-601-1967
Mailing Address - Street 1:2007 LYNN RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6519
Mailing Address - Country:US
Mailing Address - Phone:336-601-1967
Mailing Address - Fax:
Practice Address - Street 1:2007 LYNN RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6519
Practice Address - Country:US
Practice Address - Phone:336-601-1967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-04
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health