Provider Demographics
NPI:1902261407
Name:CHAMPION HOSPICE, LLC
Entity Type:Organization
Organization Name:CHAMPION HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-793-5388
Mailing Address - Street 1:20851 FM 1485 RD
Mailing Address - Street 2:
Mailing Address - City:NEW CANEY
Mailing Address - State:TX
Mailing Address - Zip Code:77357-7329
Mailing Address - Country:US
Mailing Address - Phone:832-793-5388
Mailing Address - Fax:832-793-5398
Practice Address - Street 1:20851 FM 1485 RD
Practice Address - Street 2:
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357-7329
Practice Address - Country:US
Practice Address - Phone:832-793-5388
Practice Address - Fax:832-793-5398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based