Provider Demographics
NPI:1669482550
Name:CUSTOMIZED HEALTH CARE SERVICES,INC.
Entity Type:Organization
Organization Name:CUSTOMIZED HEALTH CARE SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:QUEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OZIGBOH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:832-885-3278
Mailing Address - Street 1:2225 WILLIAMS TRACE BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4513
Mailing Address - Country:US
Mailing Address - Phone:832-532-0838
Mailing Address - Fax:832-532-0832
Practice Address - Street 1:2225 WILLIAMS TRACE BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4513
Practice Address - Country:US
Practice Address - Phone:832-532-0838
Practice Address - Fax:832-532-0832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2193542Medicaid
TX747000Medicare UPIN