The Custom Source Inc

LBN: The Custom Source Inc
The Custom Source Inc is an health care organization with primary practice located at 1013 Chestnut Ln Ste 120 , Matthews NC 28104-8567. The organization recently has 3 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthotist, Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Prosthetic/Orthotic Supplier. Suppliers / Prosthetic/Orthotic Supplier is the primary health care specialty. The Custom Source Inc can be contacted via phone (704) 893-5457, or through Rolfes, Kasey via phone (704) 893-5457.

Contact Information

Primary practice address
1013 Chestnut Ln Ste 120 Matthews NC 28104-8567
Phone: (704) 893-5457
Fax: (704) 973-0696
Website:
Map and Directions
Authorized official contact:
Name: Rolfes, Kasey DHA, ATC
Phone: (704) 893-5457

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthotist 222Z00000X
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X
Suppliers / Prosthetic/Orthotic Supplier 335E00000X

Profile Details

NPI number 1114902665
LBN Legal business name The Custom Source Inc
DBA Doing business as
Authorized official Rolfes, Kasey DHA, ATC
Entity Organization
Organization subpart 1 No
Enumeration date Dec 7th, 2005
Last updated Jul 21st, 2022 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114902665 NPPES
Other 0491E BC/BS/NC
MEDICAID 7700578 BC/BS/NC

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