Healthcare Provider Details

I. General information

NPI: 1386667277
Provider Name (Legal Business Name): CAPITAL HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 MCCORMICK DR STE 180
LARGO MD
20774-5345
US

IV. Provider business mailing address

3180 FAIRVIEW PARK DR STE 600
FALLS CHURCH VA
22042-4516
US

V. Phone/Fax

Practice location:
  • Phone: 301-883-0866
  • Fax: 301-883-0925
Mailing address:
  • Phone: 703-351-2807
  • Fax: 703-532-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberH1541
License Number StateMD

VIII. Authorized Official

Name: COLLEEN OTOOLE
Title or Position: DIRECTOR, PRACTICE MANAGEMENT
Credential:
Phone: 703-531-6209