Provider Demographics
NPI:1346251600
Name:CUSTOM HOME HEALTH, INC.
Entity Type:Organization
Organization Name:CUSTOM HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSSEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-629-2880
Mailing Address - Street 1:888 W BIG BEAVER RD STE 900
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4771
Mailing Address - Country:US
Mailing Address - Phone:248-629-2880
Mailing Address - Fax:248-629-2885
Practice Address - Street 1:888 W BIG BEAVER RD STE 900
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4771
Practice Address - Country:US
Practice Address - Phone:248-629-2880
Practice Address - Fax:248-629-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
237707Medicare Oscar/Certification