| The Champion Therapy Center Llc | |
|
1125 Commercial Dr Lexington KY 40505-3815 | |
| (859) 309-5923 | |
| Not Available |
| Full Name | The Champion Therapy Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1125 Commercial Dr, Lexington, Kentucky |
| Authorized Official Name and Position | Daisy Brown (OWNER) |
| Authorized Official Contact | 8593095923 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Champion Therapy Center Llc 1125 Commercial Dr Lexington KY 40505-3815 Ph: (859) 309-5923 | The Champion Therapy Center Llc 1125 Commercial Dr Lexington KY 40505-3815 Ph: (859) 309-5923 |
| NPI Number | 1043852619 |
|---|---|
| Provider Enumeration Date | 10/15/2019 |
| Last Update Date | 12/10/2021 |
| Certification Date | 12/10/2021 |
| Medicare PECOS PAC ID | 7113350794 |
|---|---|
| Medicare Enrollment ID | O20191212001824 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043852619 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Daisy Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235678160 PECOS PAC ID: 8022441609 Enrollment ID: I20191212001951 |
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