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General NPI Number Information
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NPI Number | 1922185677
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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 | 11/01/2006
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 7801 E BUSH LAKE RD STE 100
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City | MINNEAPOLIS
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State | MN
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Zip | 55439-3111
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Country | US
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Telephone | 952-914-0269
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Fax | 952-960-0239
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Provider Business Mailing Address
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Address Line | 7801 E BUSH LAKE RD STE 100
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City | MINNEAPOLIS
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State | MN
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Zip | 55439-3111
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Country | US
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Telephone | 952-914-0269
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Fax | 952-960-0239
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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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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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