Provider Demographics
NPI:1124211339
Name:CUSTOM STAFFING BELLEFONTAINE INC
Entity Type:Organization
Organization Name:CUSTOM STAFFING BELLEFONTAINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:D
Authorized Official - Middle Name:ROCHE
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-221-3838
Mailing Address - Street 1:165 REYNOLDS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311
Mailing Address - Country:US
Mailing Address - Phone:937-592-5006
Mailing Address - Fax:937-592-0322
Practice Address - Street 1:165 REYNOLDS AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311
Practice Address - Country:US
Practice Address - Phone:937-592-5006
Practice Address - Fax:937-592-0322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health