Provider Demographics
NPI:1487470860
Name:CHAMPIONS OF CARING CONNECTIONS
Entity type:Organization
Organization Name:CHAMPIONS OF CARING CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETTYE
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-635-9536
Mailing Address - Street 1:PO BOX 5253
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90224-5253
Mailing Address - Country:US
Mailing Address - Phone:310-635-9536
Mailing Address - Fax:310-933-8966
Practice Address - Street 1:1019 N HARRIS AVE
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-2421
Practice Address - Country:US
Practice Address - Phone:310-635-9536
Practice Address - Fax:310-933-8966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management