Provider Demographics
NPI:1245882588
Name:HOME OF CHAMPIONS
Entity type:Organization
Organization Name:HOME OF CHAMPIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-899-3132
Mailing Address - Street 1:7816 WHITNEY LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-6168
Mailing Address - Country:US
Mailing Address - Phone:817-899-3132
Mailing Address - Fax:888-588-4001
Practice Address - Street 1:7816 WHITNEY LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-6168
Practice Address - Country:US
Practice Address - Phone:817-899-3132
Practice Address - Fax:888-588-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility