Provider Demographics
NPI:1285956847
Name:CHAMPS AT HOME, INC.
Entity type:Organization
Organization Name:CHAMPS AT HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN/HOME CARE ADMIN
Authorized Official - Phone:405-600-3488
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-0357
Mailing Address - Country:US
Mailing Address - Phone:405-600-3488
Mailing Address - Fax:
Practice Address - Street 1:4920 N MERIDIAN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2301
Practice Address - Country:US
Practice Address - Phone:405-600-3488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7930251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health