Healthcare Provider Details

I. General information

NPI: 1811843766
Provider Name (Legal Business Name): BB CUSTORIA HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5534 SAINT JOE RD
FORT WAYNE IN
46835-3328
US

IV. Provider business mailing address

5534 SAINT JOE RD
FORT WAYNE IN
46835-3328
US

V. Phone/Fax

Practice location:
  • Phone: 930-444-0049
  • Fax:
Mailing address:
  • Phone: 930-444-0049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ASHU BECHEMNYOU
Title or Position: CEO
Credential:
Phone: 443-839-6761