MEDICARE: CAPITOL CARE, INC

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	:	1699131086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPITOL CARE, INC

Provider Business Mailing Address
First Line	:	185 STATE ROUTE 183
Second Line	:
City	:	STANHOPE
State	:	NJ
Zip	:	07874-2646
Country	:	US
Telephone Number	:	973-426-1440
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 RICHARD DR
Second Line	:
City	:	MT ARLINGTON
State	:	NJ
Zip	:	07856-1229
Country	:	US
Telephone Number	:	973-426-1440
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANDREW LUTZ
Credential	:
Telephone Number	:	973-804-0325

Provider Enumeration Date	:	01/14/2016
Last Update Date	:	01/14/2016

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