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Organization

CUSTOMCARE CBC, LLC

Active
Other names
Amivie, CustomCARE
Organization subpart
No

Provider details

NPI number
Authorized official
KENNETH DUARTE (CFO)
(336) 553-5912
Entity
Organization

Contact information

Practice address
7801 E BUSH LAKE RD STE 100, MINNEAPOLIS, MN 55439-3111
(952) 914-0269
(952) 960-0239
Mailing address
7801 E BUSH LAKE RD STE 100, MINNEAPOLIS, MN 55439-3111
(952) 914-0269
(952) 960-0239

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
349413
MN
251E00000X
Home Health Agency
807970600
MN
251J00000X
Nursing Care Agency

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1841460383
MN
01
416174
MDH- TEMPORARY COMPREHENSIVE HOME CARE LICENSE
MN
Enumeration date
03/11/2008
Last updated
09/17/2025
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