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General NPI Number Information
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NPI Number | 1891868204
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Entity Type | Organization
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Legal Business Name | CUSTOM HEALTHCARE
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 03/08/2019
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Provider Practice Location Address
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Address Line | 6227 LEE HIGHWAY SUITE I
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City | CHATTANOOGA
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State | TN
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Zip | 37421
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Country | US
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Telephone | 423-893-9335
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Fax | 423-893-9336
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Provider Business Mailing Address
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Address Line | 3700 BRAINERD RD
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City | CHATTANOOGA
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State | TN
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Zip | 37411-3603
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Country | US
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Telephone | 423-697-0057
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OF OPERATIONS
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Name | WANDA S KEY
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Credential | RN
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Telephone | 423-697-0057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number | 73387
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License Number State | TN
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