NPIMap

Organization Active NPI

Custom Care Healthcare, Inc.

Doing business as Custom Care Home Health - Ft. Worth

  • Home Health Agency
  • Benbrook, TX
National Provider Identifier
1073107017
Registry record updated Mar 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
CUSTOM CARE HEALTHCARE, INC.
Doing business as
Custom Care Home Health - Ft. Worth
Frontier Home Health
Practice address
6410 Southwest Blvd Ste 127
Benbrook, TX 76109-6918
Phone
(817) 847-8888
NPI assigned
Feb 20, 2021
Last updated
Mar 16, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amber L Tueller
Title
Secretary
Phone
(208) 207-2726

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU Primary

Addresses

Primary practice location

6410 Southwest Blvd Ste 127
Benbrook, TX 76109-6918

Mailing address

6410 Southwest Blvd Ste 127
Benbrook, TX 76109-6918
Phone (817) 847-8888

Other names 2

  • Custom Care Home Health - Ft. Worth Doing business as
  • Frontier Home Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210608003846 TX Part A Provider - Home Health Agency 2466688338 Practice locations: Benbrook, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073107017. Details of each certification follow.

Home health agency certification: CCN 458125

Legal name
CUSTOM CARE HEALTHCARE INC
Doing business as
FRONTIER HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Sep 1, 1994
Last certification
Sep 8, 2017
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Sep 12, 2012 in NV
Enrollment address
6410 Southwest Blvd
Ste 127
Benbrook, TX 76109-6918
HHA Branch

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Frontier Home HealthCCN 458125 · All quality measures
Overall star rating
4.5 of 5
Ownership
Proprietary
Certified
Sep 1, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D0890350Custom Care Healthcare, Inc Dba Frontier6410 Southwest Blvd Suite 127, Benbrook, TX 76109Certificate of waiverJun 30, 2028

National Provider Directory

National Provider Directory
Tax ID family
Custom Care Healthcare Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6410 Southwest Blvd
Ste 127
Benbrook, TX 76109
Phone (817) 847-8888

1445 Mac Arthur Dr
Ste 200
Carrollton, TX 75007
Phone (972) 815-5666

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Cornerstone Healthcare Inc Organization, Eagle, ID Corporation, For-profit 5% Or Greater Direct Ownership Interest May 1, 2021 100%
Brent Mills Individual Corporate OfficerTreasurer Mar 25, 2026
Brent Guerisoli Individual Corporate DirectorDirector and Sole Board Member Sep 20, 2022
The Pennant Group Inc Organization, Eagle, ID Corporation, For-profit 5% Or Greater Indirect Ownership Interest May 1, 2021 100%
Shelton Johnson Individual W-2 Managing EmployeeAd; Oct 27, 2025
John J Gochnour Individual Corporate OfficerPresident Aug 6, 2024
Amber Tueller Individual Corporate OfficerSecretary Aug 6, 2024

Facilities with the same owner 141

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 141

Practitioners & affiliated clinicians

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773619200000",
    "number": "1073107017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6410 SOUTHWEST BLVD STE 127",
            "city": "BENBROOK",
            "state": "TX",
            "postal_code": "761096918",
            "telephone_number": "817-847-8888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6410 SOUTHWEST BLVD STE 127",
            "city": "BENBROOK",
            "state": "TX",
            "postal_code": "761096918",
            "telephone_number": "817-847-8888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM CARE HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-20",
        "last_updated": "2026-03-16",
        "certification_date": "2026-03-16",
        "status": "A",
        "authorized_official_last_name": "TUELLER",
        "authorized_official_first_name": "AMBER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "208-207-2726"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Custom Care Home Health - Ft. Worth",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Frontier Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Benbrook, TX

Sources for this page

Verify at the official NPI Registry.