Provider Demographics
NPI:1851478309
Name:CUSTOM CARE TEAM, INC.
Entity Type:Organization
Organization Name:CUSTOM CARE TEAM, INC.
Other - Org Name:THE MEDICAL TEAM PERSONAL CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORP AR MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-227-9000
Mailing Address - Street 1:45 NE LOOP 410 STE 800
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5837
Mailing Address - Country:US
Mailing Address - Phone:210-227-9000
Mailing Address - Fax:210-224-2020
Practice Address - Street 1:1806 W STASSNEY LN STE 102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3645
Practice Address - Country:US
Practice Address - Phone:512-985-9058
Practice Address - Fax:512-985-9343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX0078383747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX389094901Medicaid
TX001027364OtherCOMMUNITY CARE CONTRACT NUMBER
TX007838OtherSTATE LICENSE