Provider Demographics
NPI:1023020435
Name:CUSTOMIZED COMPANION CARE, INC
Entity type:Organization
Organization Name:CUSTOMIZED COMPANION CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:RECREATIONAL THERAPI
Authorized Official - Phone:864-679-2601
Mailing Address - Street 1:1302 RUTHERFORD RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-3100
Mailing Address - Country:US
Mailing Address - Phone:864-679-2601
Mailing Address - Fax:864-679-2602
Practice Address - Street 1:1302 RUTHERFORD RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-3100
Practice Address - Country:US
Practice Address - Phone:864-679-2601
Practice Address - Fax:864-679-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health