Provider Demographics
NPI:1528740669
Name:CHAMPION, STEPHEN N/A (HOME HEALTH CARE AID)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:N/A
Last Name:CHAMPION
Suffix:
Gender:M
Credentials:HOME HEALTH CARE AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 SARATOGA AVE NE APT 6
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-1919
Mailing Address - Country:US
Mailing Address - Phone:202-304-5966
Mailing Address - Fax:
Practice Address - Street 1:1414 SARATOGA AVE NE APT 5
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1919
Practice Address - Country:US
Practice Address - Phone:202-304-5966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC236017216656374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide