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General NPI Number Information
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NPI Number | 1720120330
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Entity Type | Organization
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Legal Business Name | CUSTOMCARE HOME HEALTH SERVICES
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5524 ASSMBLY COURT 58
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City | SACRAMENTO
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State | CA
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Zip | 95823
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Country | US
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Telephone | 916-422-7327
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Fax | 916-422-7303
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Provider Business Mailing Address
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Address Line | 5524 ASSEMBLY CT STE 58
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City | SACRAMENTO
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State | CA
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Zip | 95823-2606
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Country | US
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Telephone | 916-422-7327
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Fax | 916-422-7303
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | KIESHA CHARLTON
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Credential |
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Telephone | 916-422-7327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | 315193
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License Number State | CA
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