Organization
CUSTOM CARING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES D WIDEMAN (MANAGING MEMBER)
(678) 396-0578
Entity
Organization
Contact information
Practice address
2304 PAR THREE WAY, LITHONIA, GA 30038-1801
(678) 396-0578
Mailing address
2304 PAR THREE WAY, LITHONIA, GA 30038-1801
(678) 396-0578
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
251J00000X
Nursing Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
GA
Other
Enumeration date
10/11/2012
Last updated
10/11/2012
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