Champaign Residential Services, Inc.

NPI #1437398054 in Lima, Ohio

Provider Information

NPI Number
1437398054
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 5, 2009
Last Updated
Feb 5, 2009

Practice Location

Address
2450 MANDOLIN DRIVE
City
Lima
State
Ohio
ZIP Code
45804
Phone
(937) 653-1320

Authorized Official

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

Specialties & Taxonomy Codes

Specialty
Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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