CUSTOM HEALTHCARE, LLC (NPI# 1366900391) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366900391 |
| Entity Type | Organization |
| Organization Name | CUSTOM HEALTHCARE, LLC |
| Other Organization Name | PHOENIX REHAB & MOBILITY |
| Practice Address |
410 Dromedary St Woodbury GA 30293-3560 |
| Mailing Address |
3700 Brainerd Rd Chattanooga TN 37411-3603 |
| Practice Telephone | 7704504227 |
| Mailing Telephone | 4236970057 |
| Enumeration Date | 2019-03-08 |
| Last Update Date | 2019-03-08 |
| Authorized Official Name | JAMES ROGERS (CEO) |
| Authorized Official Telephone | 4236970057 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 332BC3200X |
Durable Medical Equipment & Medical Supplies Specialization: Customized Equipment |
Suppliers |
| Other Name | Type Code |
|---|---|
| Phoenix Rehab & Mobility | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588122394 | Custom Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 1101 Old Creek Rd Ste A1, Athens, GA 30607-1090 | 2019-03-11 |
| 1326511643 | Custom Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 110 Palmetto Pkwy, Belton, SC 29627-2126 | 2019-01-09 |
| 1285109645 | Custom Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 48 Morrison Ln, Ringgold, GA 30736-7277 | 2018-10-11 |
| 1083195663 | Custom Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 902 12th St Ste B, Phenix City, AL 36867-5827 | 2018-08-22 |
| 1538437215 | Custom Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 201 Center Park Dr Ste 1000, Knoxville, TN 37922-2105 | 2011-12-08 |
| 1770863532 | Custom Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 806 Ulrich Ave, Louisville, KY 40219-1846 | 2011-08-25 |
| 1952451296 | Custom Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 2150 N Ocoee St Ste C, Cleveland, TN 37311-3936 | 2007-01-11 |
| 1093017642 | Custom Healthcare, LLC | Prosthetic/Orthotic Supplier | 1508 N Thornton Ave, Ste 104, Dalton, GA 30720-8516 | 2010-12-01 |
| 1730481383 | Custom Healthcare, LLC | Prosthetic/Orthotic Supplier | 2400 E Andrew Johnson Hwy, Greeneville, TN 37745-0948 | 2010-12-01 |
| 1275583783 | Custom Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 3700 Brainerd Rd, Chattanooga, TN 37411-3603 | 2006-05-12 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Indiana Business Entities | CUSTOM HEALTHCARE, LLC | 3700 Brainerd Rd, Chattanooga, TN 37411 |
| Street Address |
410 DROMEDARY ST |
| City | WOODBURY |
| State | GA |
| Zip Code | 30293-3560 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750593430 | Southwest Medical Clinic, Inc | Internal Medicine | 64 Jones Mill Road, Suite B Box 517, Woodbury, GA 30293 | 2007-05-04 |
| 1295705184 | Michael Wayne Akins | Pharmacist | 40 Forest Lane, Woodbury, GA 30293 | 2006-01-24 |
| 1972737633 | Audrey Denise Ross | Case Manager/Care Coordinator | 5760 Jones Mill Rd, Woodbury, GA 30293-2101 | 2009-05-11 |
| 1205282209 | Hillary Vickery | Speech-Language Pathologist | 356 Covered Bridge Rd, Woodbury, GA 30293-2348 | 2016-05-09 |
| 1538635255 | Timothy Peter Daniel | Nurse Practitioner | 64a Jones Mill Rd, Woodbury, GA 30293-2678 | 2018-10-20 |
| 1912564618 | Meriwether Healthcare, L.L.C. | Clinic/Center | 64a Jones Mill Rd, Woodbury, GA 30293-2678 | 2019-05-29 |
| 1881862944 | Merwiether Co Health Department | Public Health or Welfare | 18425 Main St, Woodbury, GA 30293-2933 | 2008-02-12 |
| 1710957014 | U-save-it Pharmacy Inc | Durable Medical Equipment & Medical Supplies | 18126 Main St, Woodbury, GA 30293-2945 | 2006-01-26 |
| 1790850592 | Michelle S Womble Custer | Nurse Anesthetist, Certified Registered | 65 Waddell Rd, Woodbury, GA 30293-4008 | 2006-11-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376143891 | Results-ast Jv, LLC | Physical Therapist | 324 Doolittle Road, Woodbury, TN 37190 | 2020-10-26 |
| 1841899150 | Sarah Nyandoro | Registered Nurse | 10635 Pond Curv, Woodbury, MN 55129-5810 | 2020-10-19 |
| 1538768916 | Shari Kohn | Psychologist | 20 Shadow Ln, Woodbury, NY 11797-2222 | 2020-10-18 |
| 1669079992 | Woodbury Surgery Center, LLC | Clinic/Center | 587 Bielenberg Dr Ste 100, Woodbury, MN 55125-4452 | 2020-10-09 |
| 1427655422 | Tara Tranguch | Naturopath | 74 Main Street North, Bldg 2 - Apt 204, Woodbury, CT 06798 | 2020-10-03 |
| 1780291245 | Meghan Kathleen Nilan | Dietitian, Registered | 7987 Drake Bay, Woodbury, MN 55125-1577 | 2020-09-29 |
| 1326655093 | Shane Michael Hamp | Social Worker | 1000 Radio Dr Ste 210, Woodbury, MN 55125-8444 | 2020-09-28 |
| 1578179727 | Natasha Ann Keller | Marriage & Family Therapist | 1802 Wooddale Dr Ste 101, Woodbury, MN 55125-2993 | 2020-09-22 |
| 1528674819 | Flourishing Roots Therapy LLC | Social Worker | 51 Sherman Hill Rd, Building A, Suite 202, Woodbury, CT 06798-0679 | 2020-09-22 |
| 1457967895 | Lisa Eisenbacher | Technician, Other | 731 Bielenberg Dr Ste 102-103, Woodbury, MN 55125-1700 | 2020-09-21 |
| Find all providers in WOODBURY | ||||
| Taxonomy Code | 332BC3200X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| Specialization | Customized Equipment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104392398 | Fairview Health Services | Durable Medical Equipment & Medical Supplies | 1875 Woodwinds Dr Ste 150, Woodbury, MN 55125-2518 | 2018-10-16 |
| 1497135867 | Action Dme LLC | Durable Medical Equipment & Medical Supplies | 205 S Mccrary St, Suite 3, Woodbury, TN 37190-1439 | 2015-06-01 |
| 1184775033 | Summit Orthopedics, Ltd. | Durable Medical Equipment & Medical Supplies | 1860 Wooddale Dr Ste 100, Woodbury, MN 55125 | 2007-01-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477163228 | Juanetta Barnes | Durable Medical Equipment & Medical Supplies | 2597 Thorngate Way, Acworth, GA 30101-8837 | 2020-08-06 |
| 1952919136 | Aklor Inc | Durable Medical Equipment & Medical Supplies | 2310 Parklake Dr Ne Ste 135, Atlanta, GA 30345-2913 | 2020-07-14 |
| 1285254656 | Kinetic Prosthetics & Medical Supply | Durable Medical Equipment & Medical Supplies | 3595 Hiram Douglasville Hwy Ste 102, Hiram, GA 30141-4963 | 2020-04-25 |
| 1215569843 | Jessi'ca Coley | Durable Medical Equipment & Medical Supplies | 451 Brookview Dr Ste A, Riverdale, GA 30274-7206 | 2020-02-11 |
| 1497387260 | Ogles Oxygen, LLC | Durable Medical Equipment & Medical Supplies | 5901 Goshen Springs Rd Ste G, Norcross, GA 30071-3506 | 2020-02-10 |
| 1982248969 | National Seating & Mobility, Inc. | Durable Medical Equipment & Medical Supplies | 4406 Mercer University Drive, Suite D, Macon, GA 31210-5608 | 2019-11-01 |
| 1548816283 | Daniel Arbuckle | Durable Medical Equipment & Medical Supplies | 2304 Pierce Way, Buford, GA 30519-2293 | 2019-08-16 |
| 1700438587 | Evelyn Ray LLC | Durable Medical Equipment & Medical Supplies | 12570 Lakeside Pkwy, Fayetteville, GA 30215-4002 | 2019-07-12 |
| 1073174603 | Freedom Mobility Center, Inc. | Durable Medical Equipment & Medical Supplies | 4717 Us Highway 80 E Ste 7a, Savannah, GA 31410-2943 | 2019-06-25 |
| 1790258226 | Ariana Sade Jones | Durable Medical Equipment & Medical Supplies | 1015 Casa Dr, Clarkston, GA 30021-1109 | 2019-01-08 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.