Provider Demographics
NPI:1568016756
Name:CUSTER, JESSICA LYNN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:CUSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 MILLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:HARDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07825-9613
Mailing Address - Country:US
Mailing Address - Phone:973-903-7607
Mailing Address - Fax:
Practice Address - Street 1:141 MILLBROOK RD
Practice Address - Street 2:
Practice Address - City:HARDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07825-9613
Practice Address - Country:US
Practice Address - Phone:973-903-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No347C00000XTransportation ServicesPrivate Vehicle
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child