Champion Dialysis Center LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

CHAMPION DIALYSIS CENTER LLC

Practice address

4554 Mahoning Ave NW
Warren, OH 44483-1437

Phone

(330) 847-0189

Fax

(330) 847-0194

NPI assigned

Mar 12, 2013

Last updated

Jan 13, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sara Anne Brady

Title

Chief Nursing Officer

Phone

(208) 371-7878

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673568000000",
    "number": "1063753358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4554 MAHONING AVE NW",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444831437",
            "telephone_number": "330-847-0189",
            "fax_number": "330-847-0194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4554 MAHONING AVE NW",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444831437",
            "telephone_number": "330-847-0189",
            "fax_number": "330-847-0194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPION DIALYSIS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-12",
        "last_updated": "2023-01-13",
        "certification_date": "2023-01-13",
        "status": "A",
        "authorized_official_last_name": "BRADY",
        "authorized_official_first_name": "SARA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "CHIEF NURSING OFFICER",
        "authorized_official_telephone_number": "208-371-7878"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0105624",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rickey Cesco
• Diane Chachko, PHARM.D.
• Michael Chachko
• Charone Chalou
• Shari Ann Chambers
• Champion Discount Pharmacy, LLC (Champion Discount Pharmacy)
• Champion Local School District
• Champion Med Express Care LLC
• Champion Township Trustees
• Emily Ann Chaney

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Warren, OH
• Providers in Warren, OH by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.