Provider Demographics
NPI:1003852534
Name:CUSTOM CASE MANAGEMENT
Entity Type:Organization
Organization Name:CUSTOM CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZZOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-480-0023
Mailing Address - Street 1:112 S SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-3767
Mailing Address - Country:US
Mailing Address - Phone:336-480-0023
Mailing Address - Fax:336-768-7229
Practice Address - Street 1:112 S SPRUCE ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-3767
Practice Address - Country:US
Practice Address - Phone:336-480-0023
Practice Address - Fax:336-768-7229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300346GMedicaid
NC8300346JMedicaid
NC8300346Medicaid
NC8300346BMedicaid