Champaign Residential Services, Inc.

NPI #1275771958 in London, Ohio

Provider Information

NPI Number: 1275771958
Entity Type: Organization
Organization Name: Champaign Residential Services, Inc.
Subpart: Yes (part of a larger organization)
Parent Organization: CHAMPAIGN RESIDENTIAL SERVICES, INC.
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Feb 3, 2009
Last Updated: Feb 3, 2009

Practice Location

Address: 1355 ST. RT. 38 SE
City: London
State: Ohio
ZIP Code: 43140
Phone: (937) 653-1320

Authorized Official

Name: MR. THAN JOHNSON
Title: CHIEF EXECUTIVE OFFICER
Phone: (937) 653-1320

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320600000X	Primary

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