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General NPI Number Information
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NPI Number | 1003055195
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Entity Type | Organization
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Legal Business Name | CUSTOMCARE HOME HEALTH SERVICES INC.
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Dates
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Enumeration Date | 02/12/2009
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Last Update Date | 01/17/2020
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Provider Practice Location Address
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Address Line | 8837 ELK GROVE BLVD STE AANDB
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City | ELK GROVE
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State | CA
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Zip | 95624-1828
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Country | US
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Telephone | 916-714-1155
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Fax | 916-405-3434
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Provider Business Mailing Address
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Address Line | PO BOX 2792
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City | ELK GROVE
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State | CA
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Zip | 95759-2792
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Country | US
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Telephone | 916-714-1155
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Fax | 916-714-1165
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Authorized Official
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Title or Position | OWNER/OPERATOR/ADMINISTRATOR
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Name | MS. AUDREY ACOSTA
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Credential | RN
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Telephone | 916-714-1155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 100000543
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License Number State | CA
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