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General NPI Number Information
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NPI Number | 1356139612
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Entity Type | Organization
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Legal Business Name | CUSTOMCARE CBC, LLC
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 2233 UNIVERSITY AVE W SUITE 225
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City | SAINT PAUL
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State | MN
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Zip | 55114-1696
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Country | US
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Telephone | 651-377-1122
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Fax | 888-688-3674
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Provider Business Mailing Address
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Address Line | 4000 PARAMOUNT PKWY STE 100
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City | MORRISVILLE
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State | NC
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Zip | 27560-4702
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Country | US
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Telephone | 919-390-2980
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Fax | 919-390-1888
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Authorized Official
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Title or Position | CFO
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Name | KENNETH DUARTE
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Credential |
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Telephone | 336-553-5912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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