CHAMPAIGN RESIDENTIAL SERVICES, INC. (NPI# 1164894150) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164894150 |
| Entity Type | Organization |
| Organization Name | CHAMPAIGN RESIDENTIAL SERVICES, INC. |
| Other Organization Name | CRSI |
| Practice Address |
710 S Main St Mount Vernon OH 43050-9260 |
| Mailing Address |
1150 Scioto St Po Box 29 Urbana OH 43078-2289 |
| Practice Telephone | 9376531320 |
| Practice Fax Number | 9376531321 |
| Mailing Telephone | 9376531320 |
| Mailing Fax Number | 9376531321 |
| Enumeration Date | 2015-10-29 |
| Last Update Date | 2015-10-29 |
| Authorized Official Name | SCOTT A DELONG (PRESIDENT) |
| Authorized Official Telephone | 9376531320 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | OH | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| CRSI | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780057661 | Champaign Residential Services, Inc. | Intermediate Care Facility, Mentally Retarded | 58 Orchard Park, Tiffin, OH 44883 | 2015-11-02 |
| 1700258795 | Champaign Residential Services, Inc. | Intermediate Care Facility, Mentally Retarded | 106 Mckinley Ave, Mount Vernon, OH 43050-8411 | 2015-10-29 |
| 1790156529 | Champaign Residential Services, Inc. | Intermediate Care Facility, Mentally Retarded | 200 S Norton St, Mount Vernon, OH 43050-4024 | 2015-10-20 |
| 1912146572 | Champaign Residential Services, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 141 Richard Avenue, Bellefontaine, OH 43311 | 2009-02-05 |
| 1861631426 | Champaign Residential Services, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 400 Oakland Street, Urbana, OH 43078 | 2009-02-05 |
| 1437398054 | Champaign Residential Services, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2450 Mandolin Drive, Lima, OH 45804 | 2009-02-05 |
| 1710126370 | Champaign Residential Services, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 329 East Spring Avenue, Bellefontaine, OH 43311 | 2009-02-05 |
| 1649418252 | Champaign Residential Services, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 124 Hill Street, Urbana, OH 43078 | 2009-02-04 |
| 1295973824 | Champaign Residential Services, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 334 Scioto Street, Urbana, OH 43078 | 2009-02-04 |
| 1609014224 | Champaign Residential Services, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2380 St. Rt. 68 South, Urbana, OH 43078 | 2009-02-04 |
| Street Address |
710 S MAIN ST |
| City | MOUNT VERNON |
| State | OH |
| Zip Code | 43050-9260 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043739972 | Roxanne Renee Berry | Case Manager/Care Coordinator | Bhp 8402 Blackjack Rd, Mt Vernon, OH 43050 | 2017-09-12 |
| 1477079309 | Blaine Elizabeth Barr | Case Manager/Care Coordinator | 510 Mitchell Avenue, Mount Vernon, OH 43050 | 2017-08-22 |
| 1205351004 | Knox Community Hospital | Durable Medical Equipment & Medical Supplies | 1330 Coshocton Ave., Mount Vernon, OH 43050 | 2017-08-14 |
| 1568998722 | Jami Passwaters | Case Manager/Care Coordinator | 8402 Blackjack Road, Mount Vernon, OH 43050 | 2017-05-10 |
| 1962892661 | Mount Vernon Nh LLC | Assisted Living Facility | 1135 East Gambier Street, Mount Vernon, OH 43050 | 2015-02-02 |
| 1881009017 | Pamela Robinson | Licensed Practical Nurse | 10263 Tucker Road, Mount Vernon, OH 43050 | 2014-06-26 |
| 1356756837 | Charla Sue Johnson | Licensed Practical Nurse | 228 Delano Street, Mt Vernon, OH 43050 | 2014-06-24 |
| 1588076236 | Erica Ferrell | Licensed Practical Nurse | 701 West Burgess Street, Mount Vernon, OH 43050 | 2014-05-29 |
| 1386085637 | Genesis Rehab Services | Assisted Living Facility | 6918 Wigton Road, Mount Vernon, OH 43050 | 2013-07-16 |
| 1427310473 | Jonathan Titus Hardin | Family Medicine | 1330 Coschocton Road, Mount Vernon, OH 43050 | 2012-06-14 |
| Find all providers in zip 43050 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255797254 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 9135 N Spring Garden Ln, Mount Vernon, IL 62864-6624 | 2016-01-06 |
| 1700258795 | Champaign Residential Services, Inc. | Intermediate Care Facility, Mentally Retarded | 106 Mckinley Ave, Mount Vernon, OH 43050-8411 | 2015-10-29 |
| 1790156529 | Champaign Residential Services, Inc. | Intermediate Care Facility, Mentally Retarded | 200 S Norton St, Mount Vernon, OH 43050-4024 | 2015-10-20 |
| 1972902534 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 11917 E Diana Rd, Mount Vernon, IL 62864-8873 | 2014-08-20 |
| 1124383153 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 16711 N Old Centralia Ln, Mount Vernon, IL 62864-7697 | 2012-07-05 |
| 1023371218 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 5305 Richview Rd, Mount Vernon, IL 62864-9609 | 2012-06-21 |
| 1669524401 | Developmental Planning & Services Inc | Intermediate Care Facility, Mentally Retarded | 4219 Lincolnshire Dr, Mount Vernon, IL 62864-2157 | 2007-01-18 |
| 1962576769 | Jjr Enterprises Inc | Intermediate Care Facility, Mentally Retarded | 4241 Lincolnshire Dr, Mount Vernon, IL 62864-2157 | 2006-11-20 |
| 1114371382 | The Institutes of Applied Human Dynamics, Inc. | Intermediate Care Facility, Mentally Retarded | 165 Esplanade, Mount Vernon, NY 10553-1116 | 2016-04-14 |
| 1801252804 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 4241 Lincolnshire Dr, Mount Vernon, IL 62864-2157 | 2016-01-06 |
| Find all providers in MOUNT VERNON | ||||
| City | MOUNT VERNON |
| Zip Code | 43050 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.