Healthcare Provider Details

I. General information

NPI: 1922011956
Provider Name (Legal Business Name): CUSTOM HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N 7TH ST STE 2
WEST MONROE LA
71291-4215
US

IV. Provider business mailing address

805 BROOK ST STE 402
ROCKY HILL CT
06067-3431
US

V. Phone/Fax

Practice location:
  • Phone: 318-410-9222
  • Fax: 318-410-1889
Mailing address:
  • Phone: 314-447-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number06 00002371
License Number StateLA

VIII. Authorized Official

Name: SONIA LEE VILLESCAS
Title or Position: SR MGR LICENSING & CREDENTIALING
Credential:
Phone: 314-447-7515