Healthcare Provider Details

I. General information

NPI: 1578091732
Provider Name (Legal Business Name): CAPRICCIO ELITE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 W OLDTOWN ST
GALAX VA
24333-3819
US

IV. Provider business mailing address

209 W OLDTOWN ST
GALAX VA
24333-3819
US

V. Phone/Fax

Practice location:
  • Phone: 276-237-8210
  • Fax:
Mailing address:
  • Phone: 276-221-0023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SUZI L HIATT
Title or Position: EXECUTIVE DIRECTOR
Credential: MS, CSAC
Phone: 276-221-0023