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General NPI Number Information
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NPI Number | 1912709973
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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 | 03/27/2025
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Last Update Date | 10/18/2025
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Provider Practice Location Address
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Address Line | 1540 HUMBOLDT AVE STE 101
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City | WEST ST PAUL
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State | MN
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Zip | 55118-3489
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Country | US
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Telephone | 651-352-9910
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Fax | 651-305-1150
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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