MEDICARE: CAP CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1205323565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAP CARE LLC

Provider Business Mailing Address
First Line	:	2225 E FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5125
Country	:	US
Telephone Number	:	562-477-0794
Fax Number	:

Provider Business Practice Location Address
First Line	:	2225 E FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5125
Country	:	US
Telephone Number	:	562-477-0794
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KIMETRIA RENE HAWKINS
Credential	:
Telephone Number	:	562-477-0794

Provider Enumeration Date	:	04/21/2018
Last Update Date	:	04/21/2018

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Directions to “CAP CARE LLC ” Practice Location

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