NPIMap

Organization Active NPI

Champaign Residential Services, Inc.

Doing business as Crsi

  • Intellectual Disabilities Intermediate Care Facility
  • Mount Vernon, OH
National Provider Identifier
1700258795
Registry record updated Oct 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
CHAMPAIGN RESIDENTIAL SERVICES, INC.
Doing business as
Crsi
Practice address
106 McKinley Ave
Mount Vernon, OH 43050-8411
Phone
(937) 653-1320
Fax
(937) 653-1321
NPI assigned
Oct 29, 2015
Last updated
Oct 29, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2015

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

Authorized official

Name
Scott A Delong
Title
President
Phone
(937) 653-1320

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X OH Primary

Addresses

Primary practice location

106 McKinley Ave
Mount Vernon, OH 43050-8411

Mailing address

1150 Scioto St
PO Box 29
Urbana, OH 43078-2289
Phone (937) 653-1320

Other names 1

  • CRSI Doing business as

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 1700258795. Details of each certification follow.

  • CCN 36G702 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G702

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
CRSI - MCKINLEY AVENUE HOME
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Apr 11, 2016
Last certification
Dec 4, 2025
Beds
6
Ownership / control type
Private (non-profit)
Facility address
106 McKinley Avenue
Mount Vernon, OH 43050

National Provider Directory

National Provider Directory
Tax ID family
Champaign Residential S18 organizations share this tax ID, including this one

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": "1446076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446076800000",
    "number": "1700258795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 SCIOTO ST",
            "address_2": "PO BOX 29",
            "city": "URBANA",
            "state": "OH",
            "postal_code": "430782289",
            "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": "106 MCKINLEY AVE",
            "city": "MOUNT VERNON",
            "state": "OH",
            "postal_code": "430508411",
            "telephone_number": "937-653-1320",
            "fax_number": "937-653-1321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPAIGN RESIDENTIAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-29",
        "last_updated": "2015-10-29",
        "status": "A",
        "authorized_official_last_name": "DELONG",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "937-653-1320"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CRSI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Vernon, OH

Sources for this page

Verify at the official NPI Registry.