Active NPI
Customcare Home Health Services Inc.
- Home Health Agency
- Elk Grove, CA
National Provider Identifier
1003055195
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- 100000543
- Legal business name
- CUSTOMCARE HOME HEALTH SERVICES INC.
- Practice address
- 8837 Elk Grove Blvd Ste Aandb
Elk Grove, CA 95624-1828 - Phone
- (916) 714-1155
- Fax
- (916) 405-3434
- NPI assigned
- Feb 12, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Audrey Acosta, RN
- Title
- Owner/Operator/Administrator
- Phone
- (916) 714-1155
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 100000543 | CA | Primary |
Addresses
Primary practice location
8837 Elk Grove Blvd Ste Aandb
Elk Grove, CA 95624-1828
Mailing address
PO Box 2792
Elk Grove, CA 95759-2792
Phone (916) 714-1155
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003055195 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111102000027 | CA | Part A Provider - Home Health Agency | 1759554033 | Practice locations: Elk Grove, CA |
Home health agency certification: CCN 059666
- Legal name
- CUSTOMCARE HOME HEALTH SERVICES INC.
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Jun 4, 2015
- Last certification
- Apr 27, 2018
- Ownership / control type
- Proprietary
- Organization structure
- Corporation
- Incorporated
- Dec 1, 2008 in CA
- Enrollment address
- 8837 Elk Grove Blvd
Ste a
Elk Grove, CA 95624-1828
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Customcare Home Health Services Inc
- Ownership
- Proprietary
- Certified
- Jun 4, 2015
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Physical therapy
National Provider Directory
National Provider Directory- Tax ID family
- Customcare Home Health Services Inc
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Durable Medical Equipment & Medical Supplies
- Elk Grove, CA
- NPI 1447502026
-
- Community Based Hospice Care Agency
- Elk Grove, CA
- NPI 1851858807
Locations
8837 Elk Grove Blvd
Ste A
Elk Grove, CA 95624
Phone (916) 714-1155
8837 Elk Grove Blvd
Elk Grove, CA 95624
Phone (916) 714-1155
Ownership & related parties
All disclosed owners & managing parties 1
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Audrey Acosta | 5% Or Greater Direct Ownership Interest | Dec 1, 2008 | 100% |
| Corporate Officer | Dec 1, 2008 | 100% | |
| Corporate Director | Dec 1, 2008 | 100% | |
| W-2 Managing Employee | Dec 1, 2008 | 100% | |
| Operational/Managerial Control | Dec 1, 2008 | 100% |
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Student in an Organized Health Care Education/Training Program
- Elk Grove, CA
- NPI 1093653610
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1234396800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1579219200000",
"number": "1003055195",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2792",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957592792",
"telephone_number": "916-714-1155",
"fax_number": "916-714-1165"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8837 ELK GROVE BLVD STE AANDB",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "956241828",
"telephone_number": "916-714-1155",
"fax_number": "916-405-3434"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CUSTOMCARE HOME HEALTH SERVICES INC.",
"organizational_subpart": "NO",
"enumeration_date": "2009-02-12",
"last_updated": "2020-01-17",
"certification_date": "2020-01-17",
"status": "A",
"authorized_official_last_name": "ACOSTA",
"authorized_official_first_name": "AUDREY",
"authorized_official_title_or_position": "OWNER/OPERATOR/ADMINISTRATOR",
"authorized_official_telephone_number": "916-714-1155",
"authorized_official_name_prefix": "Ms.",
"authorized_official_credential": "RN"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "CA",
"license": "100000543",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1003055195",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elk Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.