NPIMap

Organization Active NPI

Custom Care Healthcare, Inc.

Doing business as Custom Care Home Health

  • Home Health Agency
  • Grapevine, TX
National Provider Identifier
1861744617
Registry record updated Dec 19, 2025
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
Practice address
4811 Merlot Ave Unit 110
Grapevine, TX 76051-7389
Phone
(972) 242-5959
Fax
(972) 242-5954
NPI assigned
Oct 3, 2012
Last updated
Dec 19, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2025

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 TX Primary

Addresses

Primary practice location

4811 Merlot Ave Unit 110
Grapevine, TX 76051-7389

Mailing address

4811 Merlot Ave Unit 110
Grapevine, TX 76051-7389
Phone (972) 242-5959

Other names 1

  • Custom Care 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
O20131124000005 TX Part A Provider - Home Health Agency 2466688338 Practice locations: Grapevine, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861744617. Details of each certification follow.

Home health agency certification: CCN 679672

Legal name
CUSTOM CARE HEALTHCARE INC
Doing business as
CUSTOM CARE HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Sep 5, 2007
Last certification
Nov 21, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Sep 12, 2012 in NV
Enrollment address
4811 Merlot Ave
Unit 110
Grapevine, TX 76051-7389
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
Custom Care Home HealthCCN 679672 · All quality measures
Ownership
Proprietary
Certified
Sep 5, 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
45D1052876Custom Care Home Health4811 Merlot Ave Suite 110, Grapevine, TX 76051Certificate of waiverApr 5, 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.

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
Robert Scott Myers Individual W-2 Managing EmployeeAd; Jun 23, 2025
Cornerstone Healthcare Inc Organization, Eagle, ID Corporation, For-profit 5% Or Greater Direct Ownership Interest Jan 1, 2013 100%
Brent Mills Individual Corporate OfficerTreasurer Mar 25, 2026
Brent Guerisoli Individual Corporate DirectorDirector & Sole Board Member Sep 20, 2022
The Pennant Group Inc Organization, Eagle, ID Corporation, For-profit 5% Or Greater Indirect Ownership Interest Oct 1, 2019 100%
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

NPI Registry JSON

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

{
    "created_epoch": "1349222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766102400000",
    "number": "1861744617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4811 MERLOT AVE UNIT 110",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760517389",
            "telephone_number": "972-242-5959",
            "fax_number": "972-242-5954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4811 MERLOT AVE UNIT 110",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760517389",
            "telephone_number": "972-242-5959",
            "fax_number": "972-242-5954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM CARE HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-03",
        "last_updated": "2025-12-19",
        "certification_date": "2025-12-19",
        "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": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Custom Care Home Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Custom Care Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grapevine, TX

Sources for this page

Verify at the official NPI Registry.