Healthcare Provider Details

I. General information

NPI: 1578195046
Provider Name (Legal Business Name): CAPITOL CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MADISON AVENUE
NEWTON NJ
07874
US

IV. Provider business mailing address

185 ROUTE 183
STANHOPE NJ
07874
US

V. Phone/Fax

Practice location:
  • Phone: 844-437-3482
  • Fax:
Mailing address:
  • Phone: 844-437-3482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KERI FRADE
Title or Position: DIRECTOR OF SUPPORT SERVICES
Credential:
Phone: 844-437-3482