Provider Demographics
NPI:1124325204
Name:CUSTOM HOME CARE
Entity type:Organization
Organization Name:CUSTOM HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:LANGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:806-337-5296
Mailing Address - Street 1:701 PARK PLACE AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-4005
Mailing Address - Country:US
Mailing Address - Phone:806-337-5292
Mailing Address - Fax:806-356-9586
Practice Address - Street 1:1400 W. 14TH
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-4005
Practice Address - Country:US
Practice Address - Phone:806-337-5953
Practice Address - Fax:806-337-5174
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST COMMUNITY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health