Provider Demographics
NPI:1356139612
Name:CUSTOMCARE CBC, LLC
Entity type:Organization
Organization Name:CUSTOMCARE CBC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DUARTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-553-5912
Mailing Address - Street 1:4000 PARAMOUNT PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-4702
Mailing Address - Country:US
Mailing Address - Phone:919-390-2980
Mailing Address - Fax:919-390-1888
Practice Address - Street 1:2233 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 225
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1696
Practice Address - Country:US
Practice Address - Phone:651-377-1122
Practice Address - Fax:888-688-3674
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUSTOMCARE CBC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-28
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health