Healthcare Provider Details

I. General information

NPI: 1245346154
Provider Name (Legal Business Name): CAPITOL CITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9052 GALEWOOD DR
AUSTIN TX
78758-6437
US

IV. Provider business mailing address

9052 GALEWOOD DR
AUSTIN TX
78758-6437
US

V. Phone/Fax

Practice location:
  • Phone: 512-836-9172
  • Fax: 512-834-4376
Mailing address:
  • Phone: 512-836-9172
  • Fax: 512-834-4376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateTX

VIII. Authorized Official

Name: MS. TERRI L BEARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 512-836-9172