Provider Demographics
NPI:1255686119
Name:CUSTOM CARE AND COACH
Entity Type:Organization
Organization Name:CUSTOM CARE AND COACH
Other - Org Name:WHITNEY V. LA ROCHE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:VERDIEU
Authorized Official - Last Name:LA ROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:MM,CAGS
Authorized Official - Phone:617-800-3665
Mailing Address - Street 1:27 MONPONSET ST
Mailing Address - Street 2:MATTAPAN
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02126-3011
Mailing Address - Country:US
Mailing Address - Phone:617-800-3665
Mailing Address - Fax:
Practice Address - Street 1:27 MONPONSET ST
Practice Address - Street 2:MATTAPAN
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02126-3011
Practice Address - Country:US
Practice Address - Phone:617-800-3665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health