CHAMPAIGN RESIDENTIAL SERVICES, INC. (NPI# 1437398054) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437398054 |
| Entity Type | Organization |
| Organization Name | CHAMPAIGN RESIDENTIAL SERVICES, INC. |
| Other Organization Name | MARY ANN BROWN RESIDENTIAL FACILITY |
| Practice Address |
2450 Mandolin Drive Lima OH 45804 |
| Mailing Address |
Po Box 29 Urbana OH 43078-0029 |
| Practice Telephone | 9376531320 |
| Mailing Telephone | 9376531320 |
| Mailing Fax Number | 9376531321 |
| Enumeration Date | 2009-02-05 |
| Last Update Date | 2009-02-05 |
| Authorized Official Name | MR. THAN JOHNSON (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 9376531320 |
| Is Organization Subpart | Y |
| Parent Organization Name | CHAMPAIGN RESIDENTIAL SERVICES, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 0459301 | 05 |
| Other Name | Type Code |
|---|---|
| Mary Ann Brown Residential Facility | Other Name - Individual/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 |
| 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 |
| 1437397031 | Champaign Residential Services, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 809 South High Street, Urbana, OH 43078 | 2009-02-04 |
| Street Address |
2450 MANDOLIN DRIVE |
| City | LIMA |
| State | OH |
| Zip Code | 45804 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134729817 | Luke Holliday | Pharmacist | Sams Club Pharmacy, 1150 Greely Chapel Rd, Lima, OH 45804 | 2020-10-30 |
| 1306482393 | Olympia Monik Johnson | Case Manager/Care Coordinator | 799 S. Main St, Lima, OH 45804 | 2019-11-25 |
| 1982260139 | Jenna Renee Warnecke | Speech-Language Pathologist | Shawnee Manor, 2535 Fort Amanda Rd, Lima, OH 45804 | 2019-05-14 |
| 1942728282 | Premier Care of Ohio, LLC. | Community/Behavioral Health | 2727 St. Johns Rd, Ste D, Lima, OH 45804 | 2017-09-07 |
| 1093250078 | Gevette Love | Counselor | 311 E. Market St., Lima, OH 45804 | 2016-12-29 |
| 1134595416 | Rewa A Banks | Nurse Practitioner | 2895 Harding Hwy Ste C, Lima, OH 45804 | 2015-08-20 |
| 1295148195 | Adaptive Medical Marketing, Inc | Durable Medical Equipment & Medical Supplies | 1378 Bellefontaine Ave, Lima, OH 45804 | 2014-06-09 |
| 1265771869 | Laura B Hile | Nurse Practitioner | 1875 South Dixie Highway, Lima, OH 45804 | 2013-02-04 |
| 1184960593 | Jenna L Kimmel | Nurse Practitioner | 799 S. Main St., Lima, OH 45804 | 2012-12-13 |
| 1699965780 | Wise Footwear, LLC | Durable Medical Equipment & Medical Supplies | 1008 Bellefontaine Ave, Lima, OH 45804 | 2007-07-26 |
| Find all providers in zip 45804 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467053801 | Vip of Ohio, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2446 Audubon Rd, Akron, OH 44320-1010 | 2020-11-03 |
| 1871190280 | Gateways To Better Living Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 6000 Mahoning Ave Ste 234, Youngstown, OH 44515-2225 | 2020-10-08 |
| 1235746264 | Cheryl L Nelson | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 21891 Ringgold Southern Rd, Circleville, OH 43113-9263 | 2020-09-24 |
| 1164039244 | Amberdawn E Kenworthy-byers | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3746 Hickory Ln, Greenville, OH 45331-3014 | 2020-09-23 |
| 1467067124 | Forever Care LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 5240 Northtowne Blvd Apt C, Columbus, OH 43229-4661 | 2020-09-10 |
| 1174177737 | Alive Now Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 6717 Amsel Ave Ne, Canton, OH 44721-2606 | 2019-07-31 |
| 1154846095 | Anitra L Richardson | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3321 Hackberry St, Cincinnati, OH 45207-1701 | 2017-08-11 |
| 1811447519 | Royal Queens Care Agency | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 6625 Retton Rd, Reynoldsburg, OH 43068-2849 | 2016-10-06 |
| 1962958512 | Individual | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1111 Gonder Av Se, Canton, OH 44707 | 2016-09-01 |
| 1700238391 | Rose-mary, The Johanna Grasselli Rehabilitation and Education Center | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4383 Ammon Rd, Cleveland, OH 44143-2803 | 2016-07-07 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on CHAMPAIGN RESIDENTIAL SERVICES, INC..
| 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.