Provider Demographics
NPI:1174186779
Name:A CUSTOMIZED HOME CARE SOLUTION LLC
Entity Type:Organization
Organization Name:A CUSTOMIZED HOME CARE SOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER, ALT. ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:PALACIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-795-8668
Mailing Address - Street 1:900 E INDIANTOWN RD STE 100-3
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-5165
Mailing Address - Country:US
Mailing Address - Phone:561-899-4315
Mailing Address - Fax:561-237-1979
Practice Address - Street 1:900 E INDIANTOWN RD STE OFFICE3
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-5165
Practice Address - Country:US
Practice Address - Phone:321-795-8668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care