Provider Demographics
NPI:1275827412
Name:CUSTER CARE
Entity Type:Organization
Organization Name:CUSTER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:GLIDDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-872-6303
Mailing Address - Street 1:1020 50 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW.
Mailing Address - State:NE
Mailing Address - Zip Code:68822-1422
Mailing Address - Country:US
Mailing Address - Phone:308-872-6303
Mailing Address - Fax:308-872-2677
Practice Address - Street 1:1020 50 2ND AVE
Practice Address - Street 2:
Practice Address - City:BROKEN BOW.
Practice Address - State:NE
Practice Address - Zip Code:68822-1422
Practice Address - Country:US
Practice Address - Phone:308-872-6303
Practice Address - Fax:308-872-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251J00000X, 251X00000X, 253Z00000X, 261QA0600X
NEALF322310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No251X00000XAgenciesSupports Brokerage
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025661500Medicaid