Provider Demographics
NPI:1932546785
Name:CUSTODIAL CARE SERVICES LLC
Entity Type:Organization
Organization Name:CUSTODIAL CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-753-9888
Mailing Address - Street 1:980 US HIGHWAY 9
Mailing Address - Street 2:SUITE C, 2ND FLOOR
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-3320
Mailing Address - Country:US
Mailing Address - Phone:732-753-9888
Mailing Address - Fax:732-753-9889
Practice Address - Street 1:980 US HIGHWAY 9
Practice Address - Street 2:SUITE C, 2ND FLOOR
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-3320
Practice Address - Country:US
Practice Address - Phone:732-753-9888
Practice Address - Fax:732-753-9889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0156600251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care