Provider Demographics
NPI:1306387725
Name:CHAMP HOME CARE, LLC
Entity type:Organization
Organization Name:CHAMP HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OTUO
Authorized Official - Middle Name:SEREBOUR
Authorized Official - Last Name:ACHEAMPONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,MBA,CPA
Authorized Official - Phone:703-400-6000
Mailing Address - Street 1:12470 EVEREST PEAK LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-6733
Mailing Address - Country:US
Mailing Address - Phone:703-400-6000
Mailing Address - Fax:
Practice Address - Street 1:12470 EVEREST PEAK LN
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-6733
Practice Address - Country:US
Practice Address - Phone:703-400-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care