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General NPI Number Information
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NPI Number | 1801672449
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Entity Type | Organization
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Legal Business Name | CUSTOM CARE CASE MANAGEMENT INC
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Dates
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Enumeration Date | 09/07/2023
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 4800 SUGAR GROVE BLVD STE 308
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City | STAFFORD
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State | TX
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Zip | 77477-2639
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Country | US
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Telephone | 281-818-4780
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Fax | 281-408-4169
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Provider Business Mailing Address
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Address Line | 2011 KNOLL OAK LN
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City | ROSENBERG
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State | TX
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Zip | 77469-5732
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Country | US
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Telephone | 281-818-4780
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Fax | 281-408-4169
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. EVA CHANEL HARRIS
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Credential |
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Telephone | 281-818-4780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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