Organization
CUSTOMCARE CBC, LLC
Active
Other names
CustomCARE, Amivie
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
—
—
311Z00000X
Custodial Care Facility
Primary
—
—
385H00000X
Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
081603500
—
MN
01
—
416174
MDH- TEMPORARY COMPREHENSIVE HOME CARE LICENSE
MN
05
—
807970600
—
MN
Enumeration date
11/01/2006
Last updated
10/14/2025
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