Provider Demographics
NPI:1487808721
Name:CUSTOM QUALITY SERVICES, INC.
Entity type:Organization
Organization Name:CUSTOM QUALITY SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:REID
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:502-772-7383
Mailing Address - Street 1:3401 JEWELL AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40212-2139
Mailing Address - Country:US
Mailing Address - Phone:502-772-7383
Mailing Address - Fax:502-772-7387
Practice Address - Street 1:3401 JEWELL AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40212-2139
Practice Address - Country:US
Practice Address - Phone:502-772-7383
Practice Address - Fax:502-772-7387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management