Provider Demographics
NPI:1285163303
Name:CUSTOM CARE TEAM, INC.
Entity type:Organization
Organization Name:CUSTOM CARE TEAM, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROGRAM AND POLICY DEVE
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:VALENTINE
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN
Authorized Official - Phone:210-227-9000
Mailing Address - Street 1:45 NE LOOP 410 STE 800
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5837
Mailing Address - Country:US
Mailing Address - Phone:210-227-9000
Mailing Address - Fax:210-227-2020
Practice Address - Street 1:1902 CAMPUS COMONS DRIVE
Practice Address - Street 2:SUITE 650
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1589
Practice Address - Country:US
Practice Address - Phone:703-390-2300
Practice Address - Fax:703-390-5819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation