Provider Demographics
NPI:1407956550
Name:CUSTOM HOME CARE, INC.
Entity Type:Organization
Organization Name:CUSTOM HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:773-561-4663
Mailing Address - Street 1:2859 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1234
Mailing Address - Country:US
Mailing Address - Phone:773-561-4663
Mailing Address - Fax:773-561-2756
Practice Address - Street 1:4754 N LINCOLN AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2010
Practice Address - Country:US
Practice Address - Phone:773-561-4663
Practice Address - Fax:773-561-2756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1675283251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health