Organization · Type 2 NPI

Champaign Residential Services, Inc.

Intellectual and/or Developmental Disabilities Residential Treatment Facility · Bellefontaine, OH

NPI number 1912146572 Active

Practice location

141 Richard Avenue
Bellefontaine, OH 43311

Call (937) 653-1320 Map

Fax (937) 653-1321

Mailing address

P.o. Box 29
Urbana, OH 43078-0029

Specialties and licenses

Taxonomy	Code	License
Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary	320600000X	None listed

Intellectual and/or Developmental Disabilities Residential Treatment Facility: A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.

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NPI record

NPI: 1912146572
Entity type: Organization (Type 2)
Issued: Feb 5, 2009
Last updated: Feb 5, 2009
Status: Active
Subpart: Yes of Champaign Residential Services, Inc.

Other names

<unavail>
Richard Avenue · other name

Authorized official

Mr. Than Johnson
Chief Executive Officer
(937) 653-1320

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1912146572

Champaign Residential Services, Inc.'s National Provider Identifier is 1912146572, issued on Feb 5, 2009. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Residential Treatment Facility (320600000X), and the practice location is in Bellefontaine, OH. The record was last updated on Feb 5, 2009.