NPIMap

Organization Active NPI

Champaign Residential Services, Inc.

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Urbana, OH
National Provider Identifier
1649418252
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
124 Hill Street
Urbana, OH 43078
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

124 Hill Street
Urbana, OH 43078

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
0870008MedicaidOH

Other names 1

  • Hill Street Other name

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": "1649418252",
    "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": "124 HILL STREET",
            "city": "URBANA",
            "state": "OH",
            "postal_code": "43078",
            "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": "0870008",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hill Street",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Urbana, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2009; 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.