Provider Demographics
NPI:1508958885
Name:CUSTOM CARE SOLUTIONS, LLC
Entity Type:Organization
Organization Name:CUSTOM CARE SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KJER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-753-7224
Mailing Address - Street 1:PO BOX 1965
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-1965
Mailing Address - Country:US
Mailing Address - Phone:360-753-7224
Mailing Address - Fax:360-705-2413
Practice Address - Street 1:204 QUINCE ST NE
Practice Address - Street 2:SUITE 100
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4009
Practice Address - Country:US
Practice Address - Phone:360-753-7224
Practice Address - Fax:360-705-2413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8989CUOtherREGENCE BLUE SHIELD
WA9057852Medicaid
WA8989CUOtherREGENCE BLUE SHIELD
WA5581430001Medicare NSC