Provider Demographics
NPI:1639592470
Name:CUSTOMIZED EMPLOYMENT SOLUTIONS
Entity Type:Organization
Organization Name:CUSTOMIZED EMPLOYMENT SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:BRADLEY-DRYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-751-6523
Mailing Address - Street 1:4 EAST ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-1406
Mailing Address - Country:US
Mailing Address - Phone:207-751-6523
Mailing Address - Fax:
Practice Address - Street 1:4 EAST ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-1406
Practice Address - Country:US
Practice Address - Phone:207-751-6523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty