NPIMap

Organization Active NPI

Custom Home Health, Inc.

  • Home Health Agency
  • Troy, MI
National Provider Identifier
1346251600
Registry record updated Mar 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
CUSTOM HOME HEALTH, INC.
Practice address
888 W Big Beaver Rd Ste 900
Troy, MI 48084-4771
Phone
(248) 629-2880
Fax
(248) 629-2885
NPI assigned
Aug 11, 2006
Last updated
Mar 18, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2021

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

Authorized official

Name
Sean Fossee
Title
Owner
Phone
(248) 629-2880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

888 W Big Beaver Rd Ste 900
Troy, MI 48084-4771

Mailing address

888 W Big Beaver Rd Ste 900
Troy, MI 48084-4771
Phone (248) 629-2880

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051228000220 MI Part A Provider - Home Health Agency 6901828425 Practice locations: Troy, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346251600. Details of each certification follow.

Home health agency certification: CCN 237707

Legal name
CUSTOM HOME HEALTH INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Oct 30, 2007
Last certification
Nov 7, 2013
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Mar 22, 2011 in MI
Enrollment address
888 W Big Beaver Rd
Ste 900
Troy, MI 48084-4736
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Custom Home HealthCCN 237707 · All quality measures
Overall star rating
4 of 5
Ownership
Proprietary
Certified
Oct 30, 2007
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
23D1047485Custom Home Health, Inc888 W Big Beaver Road Suite 900, Troy, MI 48084Certificate of waiverNov 6, 2027

National Provider Directory

National Provider Directory

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

202 E 3rd St
Royal Oak, MI 48067
Phone (248) 629-2880

512 E 11 Mile Rd
Ste 100
Royal Oak, MI 48067
Phone (248) 629-2880

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Donald J Reynolds Individual 5% Or Greater Direct Ownership InterestOwner / Director Jul 1, 2022 80%
Corporate DirectorOwner / Director Apr 13, 2011
Angela Langford Individual W-2 Managing EmployeeDirector of Clinical Services Jun 7, 2019
Andrew J Scarfone Individual 5% Or Greater Direct Ownership InterestCeo / Administrator Jul 1, 2022 20%
Corporate OfficerCeo / Administrator Dec 28, 2020
W-2 Managing EmployeeCeo / Administrator Feb 22, 2021

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Custom Hospice, LLCTroy, MI, CCN 231638 Hospice 5% Or Greater Direct Ownership Interest (100%) Dec 16, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Affiliated clinicians 66

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

View all 66

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616025600000",
    "number": "1346251600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 W BIG BEAVER RD STE 900",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480844771",
            "telephone_number": "248-629-2880",
            "fax_number": "248-629-2885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "888 W BIG BEAVER RD STE 900",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480844771",
            "telephone_number": "248-629-2880",
            "fax_number": "248-629-2885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM HOME HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A",
        "authorized_official_last_name": "FOSSEE",
        "authorized_official_first_name": "SEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-629-2880"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Troy, MI

Sources for this page

Verify at the official NPI Registry.