Healthcare Provider Details

I. General information

NPI: 1851478309
Provider Name (Legal Business Name): CUSTOM CARE TEAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 W STASSNEY LN STE 102
AUSTIN TX
78745-3645
US

IV. Provider business mailing address

45 NE LOOP 410 STE 800
SAN ANTONIO TX
78216-5837
US

V. Phone/Fax

Practice location:
  • Phone: 512-985-9058
  • Fax: 512-985-9343
Mailing address:
  • Phone: 210-227-9000
  • Fax: 210-224-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number007838
License Number StateTX

VIII. Authorized Official

Name: MR. RYAN GRISARD
Title or Position: VICE PRESIDENT / CFO
Credential:
Phone: 703-390-2321