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General NPI Number Information
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NPI Number | 1275827412
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Entity Type | Organization
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Legal Business Name | CUSTER CARE
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Dates
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Enumeration Date | 06/06/2011
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 1020 50 2ND AVE
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City | BROKEN BOW.
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State | NE
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Zip | 68822-1422
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Country | US
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Telephone | 308-872-6303
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Fax | 308-872-2677
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Provider Business Mailing Address
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Address Line | 1020 50 2ND AVE
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City | BROKEN BOW.
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State | NE
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Zip | 68822-1422
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Country | US
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Telephone | 308-872-6303
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Fax | 308-872-2677
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TIFFANY ALICE GLIDDEN
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Credential |
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Telephone | 308-872-6303
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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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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | ALF322
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License Number State | NE
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