Provider Demographics
NPI:1831475128
Name:CUSTOMIZED HEALTH SOLUTIONS, LLC
Entity Type:Organization
Organization Name:CUSTOMIZED HEALTH SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KONING
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:248-795-5494
Mailing Address - Street 1:PO BOX 1547
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48068-1547
Mailing Address - Country:US
Mailing Address - Phone:248-795-5494
Mailing Address - Fax:
Practice Address - Street 1:1015 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3361
Practice Address - Country:US
Practice Address - Phone:248-353-9460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service