Provider Demographics
NPI:1326097577
Name:CUSTOM REHAB SOLUTIONS, INC.
Entity Type:Organization
Organization Name:CUSTOM REHAB SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:CUMBERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-317-5022
Mailing Address - Street 1:517 LIBERTY RD
Mailing Address - Street 2:BLDG 2 SUITE C
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8028
Mailing Address - Country:US
Mailing Address - Phone:601-664-1090
Mailing Address - Fax:601-664-1091
Practice Address - Street 1:517 LIBERTY RD
Practice Address - Street 2:BLDG 2 SUITE C
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8028
Practice Address - Country:US
Practice Address - Phone:601-664-1090
Practice Address - Fax:601-664-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06981/11.1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03175733Medicaid
MS03175733Medicaid