Provider Demographics
NPI:1255500369
Name:CUSTOM STAFFING-MANSFIELD, INC.
Entity Type:Organization
Organization Name:CUSTOM STAFFING-MANSFIELD, 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 1:1115 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2251
Mailing Address - Country:US
Mailing Address - Phone:419-756-0030
Mailing Address - Fax:419-756-8033
Practice Address - Street 1:1115 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2251
Practice Address - Country:US
Practice Address - Phone:419-756-0030
Practice Address - Fax:419-756-8033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health