NPIMap

Organization Active NPI

Champaign Residential Services, Inc.

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Bellefontaine, OH
National Provider Identifier
1578701199
Registry record updated Feb 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
CHAMPAIGN RESIDENTIAL SERVICES, INC.
Practice address
821 West Williams Street
Bellefontaine, OH 43311
Phone
(937) 653-1320
Fax
(937) 653-1321
NPI assigned
Feb 4, 2009
Last updated
Feb 4, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
CHAMPAIGN RESIDENTIAL SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 4, 2009

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X NU Primary

Addresses

Primary practice location

821 West Williams Street
Bellefontaine, OH 43311

Mailing address

P.O. Box 29
Urbana, OH 43078-0029
Phone (937) 653-1320

Other identifiers 1

IdentifierTypeStateIssuer
0123986MedicaidOH

Other names 1

  • Williams Street Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1578701199. Details of each certification follow.

  • CCN 36G496 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G496

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
WILLIAMS STREET HOME
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Mar 14, 1995
Last certification
Oct 21, 2025
Beds
5
Ownership / control type
Private (non-profit)
Facility address
821 West Williams Street
Bellefontaine, OH 43311

National Provider Directory

National Provider Directory
Tax ID family
Champaign Residential Services Inc18 organizations share this tax ID, including this one
Part of
Champaign Residential Services Inc

Other organizations with this tax ID 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1233705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233705600000",
    "number": "1578701199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 29",
            "city": "URBANA",
            "state": "OH",
            "postal_code": "430780029",
            "telephone_number": "937-653-1320",
            "fax_number": "937-653-1321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 WEST WILLIAMS STREET",
            "city": "BELLEFONTAINE",
            "state": "OH",
            "postal_code": "43311",
            "telephone_number": "937-653-1320",
            "fax_number": "937-653-1321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPAIGN RESIDENTIAL SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHAMPAIGN RESIDENTIAL SERVICES, INC.",
        "enumeration_date": "2009-02-04",
        "last_updated": "2009-02-04",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "THAN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "937-653-1320",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0123986",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Williams Street",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bellefontaine, OH

Sources for this page

Verify at the official NPI Registry.