NPIMap

Organization Active NPI

Champion Family Healthcare Services, LLC

  • In Home Supportive Care Agency
  • Winston Salem, NC
National Provider Identifier
1497266365
Registry record updated Oct 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
License
HC1170 Issued in NC
Legal business name
CHAMPION FAMILY HEALTHCARE SERVICES, LLC
Doing business as
Keston Care
Practice address
1410 Millgate Dr Ste a
Winston Salem, NC 27103-1336
Phone
(336) 608-4612
Fax
(336) 608-4739
NPI assigned
Oct 19, 2017
Organization subpart
Yes
Parent organization
CHAMPION FAMILY HEALTHCARE SERVICES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 23, 2017

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

Authorized official

Name
Antoinette Lois Van-Riel
Title
Executive Director
Phone
(336) 608-4612

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X HC1170 NC
In Home Supportive Care Agency 253Z00000X HC1170 NC Primary

Addresses

Primary practice location

1410 Millgate Dr Ste a
Winston Salem, NC 27103-1336

Mailing address

1410 Millgate Dr Ste a
Winston Salem, NC 27103-1336
Phone (336) 608-4612

Other identifiers 2

IdentifierTypeStateIssuer
34008537MedicaidNC
6600279MedicaidNC

Other names 1

  • Keston Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Champion Family Healthcare Services LLC2 organizations share this tax ID, including this one
Part of
Champion Family Healthcare Services LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1410 Millgate Dr
Ste A
Winston Salem, NC 27103
Phone (336) 608-4612

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1508371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508716800000",
    "number": "1497266365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1410 MILLGATE DR STE A",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031336",
            "telephone_number": "336-608-4612",
            "fax_number": "336-608-4739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 MILLGATE DR STE A",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031336",
            "telephone_number": "336-608-4612",
            "fax_number": "336-608-4739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPION FAMILY HEALTHCARE SERVICES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHAMPION FAMILY HEALTHCARE SERVICES, LLC",
        "enumeration_date": "2017-10-19",
        "last_updated": "2017-10-23",
        "status": "A",
        "authorized_official_last_name": "VAN-RIEL",
        "authorized_official_first_name": "ANTOINETTE",
        "authorized_official_middle_name": "LOIS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "336-608-4612"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NC",
            "license": "HC1170",
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NC",
            "license": "HC1170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34008537",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6600279",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Keston Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2017; 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.