Organization
CUSTOM CARE ORTHOTICS AND PROSTHETICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL HOUSKA (OWNER)
(740) 344-4925
Entity
Organization
Contact information
Practice address
1125 HEBRON RD, HEATH, OH 43056-1158
(740) 344-4925
(740) 344-4926
Mailing address
1125 HEBRON RD, HEATH, OH 43056-1158
(740) 344-4925
(740) 344-4926
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
OH
335E00000X
Prosthetic/Orthotic Supplier
Primary
LO-0107
OH
335E00000X
Prosthetic/Orthotic Supplier
LP-146
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0119341
—
OH
01
—
ANTHEM
000000155239
OH
01
—
NORTHWOOD
80457
OH
Enumeration date
06/09/2005
Last updated
01/29/2018
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