Healthcare Provider Details

I. General information

NPI: 1902256621
Provider Name (Legal Business Name): CAPACITY BUILDERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 W BROADWAY
FARMINGTON NM
87401
US

IV. Provider business mailing address

418 W BROADWAY
FARMINGTON NM
87401
US

V. Phone/Fax

Practice location:
  • Phone: 505-324-6568
  • Fax:
Mailing address:
  • Phone: 505-324-6568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number56885
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number56885
License Number StateNM

VIII. Authorized Official

Name: DEBBIE OFTEDAHL
Title or Position: BOARD OF DIRECTORS
Credential:
Phone: 505-326-4245