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General NPI Number Information
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NPI Number | 1124325204
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Entity Type | Organization
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Legal Business Name | CUSTOM HOME CARE
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Dates
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Enumeration Date | 02/25/2011
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Last Update Date | 02/25/2011
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Provider Practice Location Address
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Address Line | 1400 W. 14TH
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City | AMARILLO
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State | TX
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Zip | 79101-4005
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Country | US
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Telephone | 806-337-5953
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Fax | 806-337-5174
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Provider Business Mailing Address
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Address Line | 701 PARK PLACE AVE
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City | AMARILLO
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State | TX
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Zip | 79101-4005
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Country | US
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Telephone | 806-337-5292
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Fax | 806-356-9586
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | DR. WESLEY LEROY LANGHAM
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Credential | PH.D.
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Telephone | 806-337-5296
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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 |
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License Number State |
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