Champion Nursing Services, Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

CHAMPION NURSING SERVICES, INC

Doing business as

Champion Hospice, Inc

Practice address

2365 Wall St SE Ste 210
Conyers, GA 30013-2197

Phone

(404) 719-0631

Fax

(678) 658-7634

NPI assigned

Oct 1, 2020

Organization subpart

No

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

Authorized official

Name

Kethy MichelNPI 1164665279

Title

Administrator

Phone

(404) 719-0631

Specialties & licenses 1

Addresses

Other names 1

• Champion Hospice, Inc Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801493937. Details of each certification follow.

• CCN 851551 Hospice · Active · Details

Hospice certification: CCN 851551

Legal name

CHAMPION NURSING SERVICES, INC.

Certification status

Active

Provider type (POS)

Hospice

Participating since

Oct 15, 2021

Last certification

Oct 15, 2021

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Jul 9, 2020 in GA

Enrollment address

2365 Wall St SE
Ste 210
Conyers, GA 30013-2197

Listed as

Champion Hospice IncCCN 851551 · All quality measures

Ownership

For-Profit

Certified

Oct 15, 2021

Medicare certification status

ActiveFrom the Provider of Services file

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kethy M Michel, RN

  • Registered Nurse
  • Covington, GA
  • NPI 1164665279
  Authorized official Same address or phone

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

{
    "created_epoch": "1601510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601510400000",
    "number": "1801493937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2365 WALL ST SE STE 230",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300132197",
            "telephone_number": "404-587-0945",
            "fax_number": "678-658-7634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2365 WALL ST SE STE 210",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300132197",
            "telephone_number": "404-719-0631",
            "fax_number": "678-658-7634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAMPION NURSING SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-01",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A",
        "authorized_official_last_name": "MICHEL",
        "authorized_official_first_name": "KETHY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "404-719-0631"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Champion Hospice, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• CCC Medical Inc (Woodward's Express Care Pharmacy)
• Cecelia Patrice Kane MDPC
• Center for Sight PC (Center For Sight)
• Judith T Chabot, FNP-C
• Veronica Chambliss, CRNA
• Champions Nursing Services, LLC (Grace Hospice Care)
• Chantay Golson (Purpose Community Therapeutic Services, LLC)
• Andre Chapman
• Jeanna Chapman, MSW
• Nondi C Chappell, M. ED CCC-SLP

• Community Based Hospice Care Agency in Conyers, GA
• Providers in Conyers, GA by specialty
• Community Based Hospice Care Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.