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General NPI Number Information
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NPI Number | 1508958885
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Entity Type | Organization
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Legal Business Name | CUSTOM CARE SOLUTIONS, LLC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 10/22/2009
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Provider Practice Location Address
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Address Line | 204 QUINCE ST NE SUITE 100
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City | OLYMPIA
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State | WA
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Zip | 98506-4009
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Country | US
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Telephone | 360-753-7224
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Fax | 360-705-2413
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Provider Business Mailing Address
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Address Line | PO BOX 1965
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City | OLYMPIA
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State | WA
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Zip | 98507-1965
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Country | US
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Telephone | 360-753-7224
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Fax | 360-705-2413
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MS. REBECCA A KJER
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Credential |
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Telephone | 360-753-7224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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