Provider Demographics
NPI:1215397989
Name:CUSTOMIZED CARE MANAGEMENT SERVICES, LLC
Entity Type:Organization
Organization Name:CUSTOMIZED CARE MANAGEMENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NERLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:JESTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-328-7527
Mailing Address - Street 1:4119 PARKER AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-2507
Mailing Address - Country:US
Mailing Address - Phone:561-328-7527
Mailing Address - Fax:
Practice Address - Street 1:4121 PARKER AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-2507
Practice Address - Country:US
Practice Address - Phone:561-460-2464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
FLARNP9227682363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017276500Medicaid